A physiotherapy‐led review of guideline‐based care for community‐dwelling older people presenting to a metropolitan hospital with accidental falls

Abstract

Objective(s)Several guidelines exist to inform best‐practice management of community‐dwelling fallers. This study aimed to outline a pragmatic approach to developing an audit tool for guideline‐based care of falls and provide an overview of current practice.MethodsAn audit tool to determine compliance with guideline‐based care was developed with an allied health and physiotherapy focus, utilising the Australian Commission on Safety and Quality in Health‐Care Guidelines for Preventing Falls and Harm from Falls in Older People (2009) and Queensland State Government ‘Stay on your Feet’ guidelines. A retrospective audit of medical records was completed in July 2020 of community‐dwelling people aged 65 years and over with a fall‐related emergency department (ED) presentation in a medium‐sized metropolitan hospital in Australia. Data were compared between patients admitted to hospital and those discharged home from the ED.ResultsNinety‐three patients were included: 68 were discharged home from ED and 25 were admitted to hospital. There was a significant difference in receiving an allied health review (p < .001) between admitted patients (96%) and those who discharged home from ED (68%). The Clinical Frailty Scale was only completed for 23% of patients. Physiotherapy quality‐of‐care (n = 46 patients) was variable, with poor completion of physical outcome measures (7%) and fall education (4%). However, assessment of mobility was routinely completed (94%), and most patients were referred to an appropriate community service (66%).ConclusionsAdherence to guideline‐based care of community‐dwelling fallers is inconsistent. Improvements are required in the consistency of risk stratification, comprehensive physical assessment and patient education.