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One Falls Service’s Journey

One Falls Service’s Journey. …and near death experience!. Dean Metz BSc Physiotherapist MPH. 2009: The Beginning. A “ Nurse Led ” service Physio “ on-loan ” one day a week from local hospital Minimal to no progress among patients Disinterested management

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One Falls Service’s Journey

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  1. One Falls Service’s Journey …and near death experience! Dean Metz BSc Physiotherapist MPH

  2. 2009: The Beginning • A “Nurse Led” service • Physio “on-loan” one day a week from local hospital • Minimal to no progress among patients • Disinterested management • We decide to redesign our service

  3. Changing the Assessment Original • Nurse assesses the patient • …then the patient waits for a physio assessment • …the patient waits for interventions to start Lots of waiting! New Format • Nurse and Physio assess patient together and interventions are started on the first visit. Almost no waiting beyond initial appointment!

  4. What was EVERYBODY doing?

  5. FaME and OTAGO • Insufficient staffing • Insufficient time • Overwhelming need • Could not implement properly with available resources

  6. A New Approach 6 Stage Progressive Programme • Supine • Seated with support • Seated without support • Standing with upper extremity support • Standing without support • Dynamic standing activities

  7. Kaizen!

  8. 2011: We start to enquire… • Patient Stories • 100% satisfaction with the service • People report improved: Confidence Function Walking ability Balance • We perform a small audit of 30 patients

  9. 2012: We dig deep… • Self-Audit of the service • Objective measures for risk reduction • TUG • Tinetti • FES-I • Patient reported falls for rate reduction • Financial Analysis

  10. TUG Scores decreased by 8 seconds

  11. Tinetti ScoresIncreased by nearly 6 points

  12. FES-I ScoresDecreased by nearly 6 points

  13. Number of FallsDecreased by 512

  14. What was prevented? 26 Hip Fractures 86 Other fragility Fractures 112 Ambulance Call Outs 9 Care/Nursing Home admissions

  15. The Financial Impact

  16. …More Savings

  17. Add it all up…

  18. …And about one week later..

  19. The CCG decides to drop by… Remember that “near death experience” thing…

  20. How can you build your own case? CSP Falls Economic Model Calculator POPPI NICE Costing Documents Office of National Statistics Paying for Care The Evidence Base

  21. www.poppi.org.uk Let’s look at Derby

  22. Derby’s projected older adults… 43,300 in 2020

  23. …how many of them will fall… 11760 Falls in 2020

  24. …and how many hospitalizations 946 in 2020

  25. The estimates for Derby in 2020 11760 x .05 = 588 Hip Fractures @ £5477 per Fracture = £3,220,476 588 / .30 = 1960 other fractures @ £2862 per Fracture = £4,750,920 33% of 588 = 203 care home admissions @ £24,500 per year = £4,971,876 Totaling: £12,943,272

  26. The Take Home Messages: • Collect BOTH quantitative and qualitative measures • Know how your service can impact on your population • Utilize third party and voluntary sector organizations • Be prepared to support your work with clinical and financial evidence

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