PROJECT 

Emergency Department Falls and Syncope Service (ED FASS)

 

TEAM:

Dr Robert Briggs; Ms Ciara Rice; Prof Rose Anne Kenny; Prof Conal Cunningham; Dr Amanda Lavan; 
Dr Des O’Donnell; Ms Lisa Byrne; Ms Deirdre Kelly; Ms Dympna Hade ;Ms Bindu Poulouse; Ms Lincy Joseph

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LOCATION:

St James’s Hospital Falls and Syncope Unit / Emergency Department.

 

THE PROBLEM:

Falls represent the most frequent reason older people present to the emergency department (ED) in St James’s Hospital (and across Ireland). We identified that 1/5 older people who presented to St James’s ED did so with a fall or injury related to a fall.

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Almost 60% of those ≥70 years who presented with a fall were admitted to hospital. Their resulting length of stay was long (average >12 days).

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More acute hospital inpatient 'bed days' were used managing falls than for any other complaint. Despite this, unfortunately many patients were discharged home without a diagnosis for the fall documented (44%) and re-presentation rates were high.

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THE SOLUTION:

We developed a novel ‘front door’ falls service, aiming to:

 

1. Enhance the care of the older person presenting to the emergency department with falls by:

a. Delivering ‘front door’ specialist assessment and care for patients presenting to ED.

b. Developing ambulatory care pathways for patients so they don’t need to be admitted to hospital.

c. Providing a same-day consult service for patients admitted ‘out of hours.’

 

2. The knock-on effects of this addressed patient flow issues by:

a. Preventing unnecessary hospital admission for patients with falls.

b. Reducing patient experience time in ED.

c. Shortening length of stay if admitted after a fall.

d. Reduce re-presentations with falls to the ED.

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BENEFITS:

After the service was introduced:

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• Patients with falls received specialist care at the front door, avoiding the need to be seen by the ED service.

• Admissions from ED for falls reduced by over 30%.

• The average time spent in hospital after admission with a fall reduced by 3 days.

• The number of ‘bed days’ attributable to falls care halved.

• The bed day saving (though notional) was 9,000 per annum, the equivalent of a full ward of patients with falls who were now constantly being looked after in ambulatory care rather than the acute hospital.

• Patients with falls were 30% less likely to re-present within the next 3 months.

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PROJECT CONTACT DETAILS:

Robert Briggs (rbriggs@stjames.ie)