Quality statement 6: Medical examination after an inpatient fall

Quality statement

Older people who fall during a hospital stay have a medical examination. [2015]

Rationale

When an older person falls, it is important that they have a prompt medical examination to see if they are injured. This is critical to their chances of making a full recovery. Timescales for medical examination should be included in a post-fall protocol that is followed for all older people who fall in hospital.

Quality measures

Structure

Evidence of local arrangements to ensure that NHS organisations with inpatient beds have a post-fall protocol that includes timescales for medical examination.

Data source: Local data collection. Results for 2011 were collected by the pilot audit by the Royal College of Physicians (2012) Report of the 2011 inpatient falls pilot audit, section 2: Policy, protocol and paperwork, table 2.5.1 (f).

Process

a) Proportion of falls in older people during a hospital stay where the person has a medical examination completed within 12 hours.

Numerator – the number in the denominator where the person has a medical examination completed within 12 hours.

Denominator – the number of falls in older people during a hospital stay.

Data source: Local data collection.

b) Proportion of falls in older people during a hospital stay where the person shows signs of serious injury, is highly vulnerable to injury or has been immobilised, where a fast-track medical examination is completed within 30 minutes.

Numerator – the number in the denominator where the person has a fast-track medical examination completed within 30 minutes.

Denominator – the number of falls in older people during a hospital stay where the person shows signs of serious injury, is highly vulnerable to injury or has been immobilised.

Data source: Local data collection.

Outcome

Level of harm caused by falls during a hospital stay in people aged 65 and over.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (NHS organisations with inpatient beds, such as district hospitals, mental health trusts and specialist hospitals) ensure that their staff have access to and follow a post-fall protocol that includes timescales for medical examination for older people who fall during a hospital stay.

Healthcare professionals (medically qualified) complete medical examinations within the timescales specified in their organisation's post-fall protocol for older people who fall in hospital.

Commissioners (clinical commissioning groups and NHS England) ensure that they commission services from providers that have a post-fall protocol that includes timescales for medical examination for older people who fall in hospital.

Older people who fall in hospital have a medical examination to see if they are injured, which is carried out soon after the fall.

Source guidance

National Patient Safety Agency (2011) Rapid response report: Essential care after an inpatient fall, recommendation 1

Definitions of terms used in this quality statement

Fall

A fall is defined as an unintentional or unexpected loss of balance resulting in coming to rest on the floor, the ground, or an object below knee level.

[NICE's clinical knowledge summary on falls – risk assessment]

Post-fall protocol

A post-fall protocol should include:

  • checks by healthcare professionals for signs or symptoms of fracture and potential for spinal injury before the patient is moved

  • safe manual handling methods for patients with signs or symptoms of fracture or potential for spinal injury (community hospitals and mental health units without the necessary equipment or staff expertise may be able to achieve this in collaboration with emergency services)

  • frequency and duration of neurological observations for all patients where head injury has occurred or cannot be excluded (for example, unwitnessed falls) based on the NICE guideline on head injury

  • timescales for medical examination after a fall (including fast-track assessment for patients who show signs of serious injury, are highly vulnerable to injury or have been immobilised); medical examination should be completed within a maximum of 12 hours, or 30 minutes if fast-tracked.

The post-fall protocol should be easily accessible (for example, laminated versions at nursing stations).

[Adapted from the National Patient Safety Agency's rapid response report on essential care after an inpatient fall, recommendations 1 and 2, and expert consensus]