Quality statement 6: Medical examination after an inpatient fall
Quality statement
People who fall during a hospital stay have a medical examination. [2015]
Rationale
When a person falls, it is important that they have a prompt medical examination to see if they are injured and to assess for any change in their underlying medical condition. 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 people who fall in hospital.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
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: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from service or clinical protocols.
Process
a) Proportion of falls in 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 people during a hospital stay.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
b) Proportion of falls in 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 people during a hospital stay where the person shows signs of serious injury, is highly vulnerable to injury or has been immobilised.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records. The Healthcare Quality Improvement Partnership (HQIP) Falls and fragility fracture audit National Audit of Inpatient Falls reports data on whether a medical assessment was performed within 30 minutes of the inpatient fall that resulted in a femoral fracture.
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 people who fall during a hospital stay.
Healthcare professionals complete medical examinations within the timescales specified in their organisation's post-fall protocol for people who fall in hospital.
Commissioners ensure that they commission services from providers that have a post-fall protocol that includes timescales for medical examination for people who fall in hospital.
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 Rapid response report: Essential care after an inpatient fall (2011), recommendation 1. Falls remains part of NHS England's enduring standards that remain valid from previous patient safety alerts (cross-speciality safety).
Definitions of terms used in this quality statement
Fall
A fall is defined as an unexpected event which causes a person to rest on the ground, floor or lower level. [Adapted from NICE's guideline on falls; evidence review B, table 1]
Post-fall protocol
A post-fall protocol should include:
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checks by healthcare professionals for signs or symptoms of fracture and potential for spinal injury before the patient is moved
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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)
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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
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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 opinion]