Impact case study database

Research at the University of Nottingham has led to the implementation of new clinical interventions, changes to patient care practices, mitigation of potential harm, and significant improvements in the health outcomes of patients suffering falls across the UK.

Ambulance services

Our research (R1) demonstrated that appropriate referral to the community-based Falls Prevention Service reduced the rate of falls by 55%. This led to the implementation across the East Midlands of the first-of-its-kind clinical pathway - the “Falls Ambulance”, staffed by a paramedic and specialist nurse [A]. The Associate Clinical Director of the East Midlands Ambulance Service NHS Trust stated: “ In direct response to the RCT a falls rapid response team (FRRT) was set up in Nottingham in 2013 […] the service won awards as it was the first of its kind in the UK and a number of other ambulance services followed the Nottingham lead.” [A]. The Kings Fund has included our research as an example of good practice in their 2014 report ‘ Making our health and care systems fit for an ageing population’ [B], which sets out a framework and tools to help local service leaders improve the care they provide for older people. Subsequently, 8 of the other 12 UK Ambulance Trusts have implemented a similar falls referral pathway. The reduction in pressure on over stretched emergency departments is demonstrated with examples of cost savings of GBP197,500 and a decrease of 552 attendances at A&E (a decrease of 75%) seen in East Lancashire alone between April 2016 and March 2017 [A, Royal College of Occupational Therapists report]. Data from our ambulance study has been used nationally to develop a Return on Investment (ROI) resource to help commissioners and communities provide cost-effective falls prevention activities. England’s local authorities and Clinical Commissioning Groups (CCGs) can use results from the tool to protect and improve the health of their local populations when making commissioning decisions [C].

Physical activity

Our free online and downloadable resources for commissioners to use to plan, implement and monitor the Falls Management Exercise (FaME) programme following our PHISICAL study have been downloaded 884 times (between June 2019 and May 2020). NICE endorsement of the Toolkit (October 2019) acknowledges its accurate reflection of the NICE falls guideline and quality standard [D]. Two counties in England have commissioned the programme enabling over 1,500 people access to effective falls prevention intervention [E]. The PrAISED programme led to an innovative exercise class, in the University of Nottingham’s sports centre, for people with dementia and their carers. This exercise class received BBC press coverage [F] and was attended by up to 30 people per week (between September 2017 and March 2020) (R6). This valued activity is currently paused due to COVID-19.

Care Homes

The GtACH intervention used in 87 care homes showed a significant (43%) reduction in falls in the 3-6 month period post randomisation (R8). 80% of staff in a caring role were trained. The research is impacting people’s lives: One care home manager reports “ one gentleman’s falls have reduced, he is much safer to mobilise, he’s gained confidence and that has improved and had an impact on his quality of life.” [G]. Another care home manager states “ our care home continues to use the GtACH screening and assessment tool, as we have seen the benefits in preventing, reducing and managing falls, increasing staff awareness. The tool has enabled us to communicate more effectively with our allied health care professionals and it has become an integral part of our daily practice.” [H]. A lead community research nurse states “ We have seen a positive reaction from care home personnel about the use of the GtACH programme and the falls resources by listening to feedback from care home managers” [H]. This intervention is now being rolled out nationally through a programme designed to empower care home staff to lead its adoption [h].

Free online and downloadable ‘React to Falls’ resources have been co-developed with a production company for care home staff which include a training resource, pocket sized guides, and a smartphone app, available on Android and Apple platforms [J], developed as a direct result of care homes evaluation of the paper resources [I]. The online resource has had 1,799 unique views (between April and August 2019) with approximately 10% completing all five videos in the resource [J]. 770 care homes across the UK have received ‘React to Falls’ resources developed by the UoN, and 173 have so far provided feedback via survey with 96% (161/168) saying that they are likely or very likely to use the resource in their workplace [K].

The impact described in this case study has been recognised through the award of an MBE for services to occupational therapy, to Robertson, who worked across the NHS and the University of Nottingham on this falls research [L].