Drivers. Admission in the older patient can cause: Disorientation Delirium Deconditioning and risk of further falls and/or infection

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2 Drivers Admission in the older patient can cause: Disorientation Delirium Deconditioning and risk of further falls and/or infection (NHS England/Keogh 2013)

3 Drivers Those patients that have fallen are at risk of falling again within 24 hours without immediate intervention Often the intervention needed is small (Logan 2010) TARN Data (trauma network) inform that demographics have shifted to older adults who have fallen from standing sustaining significant injury to head and chest. (Kehoe et al 2015) Local Falls Teams having difficulty reaching these patients quickly

4 An acute, multi-disciplinary, blue lit response providing on scene assessment, treatment and equipment to ensure the older patient is well, safe and functional in their own environment without the need for hospital admission.

5 Specialist Paramedic Senior/experienced level - extended skill set including wound closure, catheter care and PGD abx/analgesia Advanced Occupational Therapist ED/AMU/Elderly Care and Parkinson specialities (Experienced Band 7)

6 Experience and specialised equipment for lifting older patients

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8 Funding for the Pilot Berkshire West CCG s kindly funded the release and backfill of acute hospital occupational therapists

9 (Saturday chosen due to reduced community support) Patients over 65 who had fallen at home were selected from the incoming 999/111 emergency call stack and FFR responded in place of normal ambulance (selection bias!)

10 86 year old male lives alone.. Full assessment including wound closure OT assessment and provided with new grab rails, walking frame and toilet raiser New pendant alarm connected RACOP appointment for concern for festinating gait and general health needs

11 Quantitative Outcomes female 97 male

12 Quantitative Outcomes Presenting Complaint

13 Quantitative Outcomes

14 Quantitative Outcomes

15 Qualitative Outcomes response was brilliant as were all services involved immediately and afterwards. Thank you to all involved...excellent and faster response than when my father fell previously. We hope this service continues for others Thankful such help available. The Falls and Frailty Response staff were superb, very kind and professional

16 Highlighted Problems

17 Highlighted Problems

18 Unexpected discovery Even those patients that were admitted saw benefit from OT assessment. With the home environment viewed, and information passed to the duty OT, discharge planning begins on scene.

19 and What of the 150 discharged at Scene? 14.67% called back within 7 days Reason Admission? FFR Notes Fallen again YES 101 year old likely uti (fall/increased frequency of urine/new confusion) treated with nitrofurantoin and increased care fell again and crew admitted Fallen again GP Admission - no improvement NO YES End of Life patient deteriorating mobility maxed out on full care had all necessary equipment. Fell at home likely to be secondary to chest infection patient near off legs but refusing admission as a compromise patient covered with co-amoxiclav with GP f/u

20 Going Forward? Extend/Upgrade the Service to 3 days a week (Fri/Sat/Sun) Or (Sat/Sun/Mon)

21 Wish List Going Forward? POC Testing: CK level/u&e s could prevent long lie admissions See More Patients: Time to see at least 6 pts per day (936 as 3 day service 636 avoiding admission)

22 In Summary. Improves patient/family experience Improvement on normal ambulance response When considering provision of service, good ROI but most impacts are difficult to quantify. Looking to take to a 3 day a week service

23 and why we attempt admission avoidance

24 Thankyou Any Questions? References Kehoe A, Smith JE, Edwards A, Yates D, Lecky F (2015) The Changing Face of Major Trauma in the UK Emerg Med Journal 32: Logan PA, Coupland CAC, Gladman JRF, Sahota O, Stoner-Hobbs V, Robertson K, Tomlinson V, Ward M, Sach T and Avery AJ (2010) Community falls prevention for people who call an emergency ambulance after a fall: randomised controlled trial BMJ 340: 2102 NHS England (2013) Transforming Urgent and Emergency Care Services in in England (Keogh report) available at: