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Falls and bone health

Our vision

Falls affect 30% of people aged over 65 and 50% aged over 80 at least once a year. They are the major reason for injury, hospital attendance and admission, ambulance call-out and admission to long term care. In 2007/08, 86,000 people fell and fractured their hip in the UK; this represents the biggest cause of trauma-related hospital admission and is closely associated with premature death in older people. More than 200,000 suffered one of the other fragility fractures – wrist, pelvis, upper arm – generally from falls.

We are transforming the way we prevent and manage falls by:

  • Improving outcomes and improving the efficiency of care after hip fractures

  • Responding to the first fracture, preventing the second

  • Intervening early to restore independence

  • Preventing frailty, preserving bone health, and reducing accidents

 

The falls prevention and bone health workstream aims to radically improve patient outcomes and efficiency of care after falls and fractures over the next four years.

 

Scope

The overall scope of the falls workstream is in line with the national falls and bone health strategy, which supports the four objectives in the ‘falls and fracture care & prevention’ pyramid. These objectives will deliver the highest standard of care for all patients with falls and fragility fractures, to:

  • Improve mortality and morbidity

  • Reduce length of stay in hospital

  • Reduce healthcare expenditure

[ Zoom ]
Falls Prevention Pyramid

 

Objectives

There are four objectives to deliver the falls workstream vision, each with accompanying standards:

  • Improve patient outcomes and improve efficiency of care after hip fractures through compliance with core standards

  • Respond to a first fracture and prevent the second

  • Early intervention to restore independence – through falls care pathways, linking acute and urgent care services to secondary prevention of further injuries, reduce in-patient falls

  • Prevent frailty, promote bone health and reduce accidents – through encouraging physical activity and healthy lifestyle and reducing unnecessary environmental hazards. 

 

Benefits & Outcomes

Patient experience:

  • Increase timely access to expert medical advice for hip fracture patients;

  • Improve quality of life by early intervention following herald fractures, to improve bone health and prevent secondary fractures;
  • Increase compliance with pathways for patients presenting to urgent care with a fall or fracture;
  • Decrease length of stay for patients admitted for falls and fractures.

 

Patient Safety:

  • Increase rates of early surgery for medically fit patients with hip fractures, to the target of 36 hours from admission;

  • Reduce inpatient falls;
  • Increases effective identification of patients with fragility fractures and the assessment and treatment of these patients through a fracture liaison service.

 

Clinical Effectiveness:

  • Decrease numbers of fractures in the population, including a decrease risk for future fragility fractures;

  • Improve outcomes and reduce length of stay for hip fracture patients by increasing early mobilisation;
  • Increase number of people with a fractured hip who are jointly managed by a geriatrician and orthopaedic surgeon perioperatively;
  • Increase number of patients undergoing fragility fracture assessment and indicated treatment for osteoporosis.

 

Productivity & Efficiency

  • All Trusts treating fractured neck of femur to achieve best practice tariff;

  • Decrease the number of falls within the health economy including care homes and inpatients;
  • Decrease the cost of providing hip fracture care per Trust;
  • Increase the number of patients undergoing fragility fracture assessment and treatments for osteoporosis. 
Falls prevention

Other useful links:

Good practice case studies from the East Midlands

Check out how well the NHS is delivering quality falls care through the East Midlands Quality Observatory

Improving falls services in Leicester

A joint initiative between the NHS & HIEC to reduce falls in care environments

Hip Fracture Best Practice Tariff initiative by the NHFD

Falling Standards, Broken Promises - RCP Report of the national audit of falls and bone health in older people 2010

The drive for more Fracture Liaison Services by the National Osteoporosis Society

The Department of Health’s ‘Prevention package for older people’ resources

The Patient Safety First guide to reducing harm from falls

The British Orthopaedic Association’s ‘The Care of Patients with fragility fractures’ (The Blue Book)

The British Geriatrics Society’s ‘A commissioning toolkit for falls and fractures’