Title : Outcomes of a community falls service after initiating interdisciplinary concurrent assessments
Abstract:
Discussion: That patient’s benefit from a multifactorial assessment is now accepted as normal protocol. (NICE Clinical Guideline 161, 2013, 13) What form that takes and how it is implemented can take on a variety of shapes. In 2010 this Falls Service acquired a full time physiotherapist. This provided an opportunity for review of the existing set-up of nurses assessing patients and then deciding whether they needed referral to therapy or other interventions. Surrounding Falls Services were interviewed and observed with an aim to determine best local practice. It was decided to establish joint nursing and physio assessments in order to shorten time from assessment to intervention, ensure a more holistic approach to falls, and reduce over-assessment of patients.
Intervention: An assessment process was established which had both nursing and physio together with the patient. Each has specific tasks to perform, but each benefitted from hearing and observing the findings of the other. Patients also benefitted from telling their story only once, undergoing only a single assessment and the collaborative effort of both disciplines for an integrated plan of care in approximately one hour’s time.
Improvement: Patients were interviewed in 2011 and the qualitative feedback was overwhelmingly positive. The service performed a self –audit for the whole of 2012 on quantitative clinical outcomes. 142 patients completed an assessment and intervention. They collectively suffered 629 falls in the six months prior to assessment but only 117 falls in the six months post assessment. The mean results of the Timed Up and Go (TUG), Tinetti Balance Score and Falls Efficacy Scale – International all improved as well.
Discussion: Patients clearly benefit from the collaborative efforts of interdisciplinary working. Although this prospect can threaten role perceptions, require business manager support, and initially be more time consuming, the outcomes can greatly reduce the burden on resources in the long term.
Audience Take Away:
- The problem of falls can’t be solved by any one agency
- A reactive approach is insufficient to prevent injuries, suffering, and continued escalation of costs
- Collaborative working maintains momentum, focus, and prevents gaps in service
- Collaborative working also prevents duplication of services, unnecessary expense, and promotes accountability
