“We have been delighted to work with the YHAHSN Improvement Academy on safety huddles. The whole ward team have really embraced the safety huddle concept. We have reached the milestone of 30 days without a fall today, which given the history of falls on this ward is really significant. We don’t often get a chance to say ‘Well done!’”
Dr Alan Hart-Thomas, Clinical Director, Calderdale and Huddersfield NHS Trust
What was the problem?
Falls are a common and serious problem estimated to cost the NHS more than £2.3billion per year. The human cost of falling includes distress, pain, injury, loss of confidence, loss of independence and mortality. Impact can also be seen on family members and carers of people who fall. Inpatient groups who are seen as at most risk of falling are:
- All patients aged 65 or older
- Patients aged 50 to 64 who are judged by a clinician to be at higher risk of falling because of an underlying condition.
Inpatient falls can lead to hip fractures and other injuries, while even falls without harm can lead to loss of confidence and increased length of stay. The Yorkshire and Humber AHSN’s Improvement Academy is working with frontline teams across the region to reduce patient falls and has made significant progress.
What we did and why
Over 200,000 falls took place in NHS hospitals in England in the year ending October 2012, contributing to patients’ loss of confidence and independence, increased distress, pain, injury, increased length of stay and, in a significant number of cases, death.
The financial cost of a fall can include both significant clinical and legal costs. In summary:
- 208,720 falls in NHS hospitals in England in the year ending October 2012.
- Falls in hospitals are a common and serious problem estimated to cost the NHS more than £2.3 billion per year.
- About 30% of people 65 years of age or older have a fall each year, increasing to 50% in people 80 years of age or older.
- Patients at risk of falling in hospital are defined as aged 65 and older and those between 50 and 64 with an underlying condition that puts them at a higher risk of falling.
- Extrapolating the NICE findings, each fall in hospital costs approximately £12,000 in addition to standard cost of admission.
- Regional NHS CEOs identified this as one of the major challenges they were facing.
Our Improvement Academy support and coach frontline teams as part of the HUddles for Safety Healthcare (HUSH) programme that includes safety culture surveys, visual data and celebrating successes. We have made significant, evidenced reductions to the number of patient falls and costs, increased bed availability and achieved measurable improvements in staff morale, with teams choosing to extend their remit to include reducing pressure area injury, deteriorating patients and delayed discharge.
Before we started at Leeds Teaching Hospitals NHS Trust there were 54 falls per month across four care of the elderly wards, and eight fractures and multiple other significant injuries per year.
Three months after we started working with the four ward teams there were 23 falls per month, which are continuing to decrease. Now forecasting is at less than four fractures per year, with significant reduction in other forms of injury. All four wards now have extended periods without any falls.
Which national priorities does this work address?
- Care and Quality Gap: Variations in quality of care, variations in safety of care.
- Funding and Efficiency: Falls are estimated to cost the NHS £2.3billion per year, and inpatient falls increase length of stay and incur additional treatment costs.
We are now actively working with more than 66 front line teams across 18 organisations in Yorkshire and Humber, including two private nursing care homes and two general practice teams.
The work has resulted in impressive results, including:
- Teams achieving a significant reduction of inpatient falls, evidenced by at least one step change reduction in run charts plotting ‘falls per week’. A group of four wards has reduced the combined average number of falls per week by 60%.
- Sustained periods of time without any falls. One ward has moved from an average of one fall per week to repeatedly achieving 30 days between falls, and up to 60 days.
A preliminary health economics evaluation has shown a ROI of 388% (savings of £185k from costs of running the programme at £39k). Further health economics work is underway as part of the funded scaling up initiative. The Improvement Academy is supporting Leeds Teaching Hospitals NHS Trust, Barnsley Foundation Trust and York Foundation Trust to scale-up Team Safety Huddles as part of a Health Foundation Scaling Up programme. This £500,000 funded programme is running for two and a half years, until September 2017. There is a substantive evaluation of the impact of the patient safety huddle work at whole hospital level being provided by University of Bradford.
In March 2015 a Falls Summit in collaboration was held with three other AHSNs in the north. The event was attended by over 200 delegates.
York Health Economics Consortium (YHEC) completed an evaluation of the initial programme and the figures below are based on that report. We have spread the programme and are now working with 95 teams across 23 organisations across the region.
- The AHSN has received a £500,000 scaling up award from the Health Foundation.
- To date 1600 patients who could have fallen have not done so.
- The intervention has avoided 13 fractures forecast including #NOF.
- £1.1m was saved from direct care costs to date.
- We have extended our programme to include pressure ulcers, care of deteriorating patients and reducing delayed discharges.
Tips for implementation
- Clinical and project leadership.
- Whole system support, including CEOs of acute trusts and CCGs.
- Learning sets.
- AHSNs will need to be supported to develop their own capability in delivering the active ingredients of this methodology – and then supported to use the spread methodology.
Next steps and spread
Scaling up of this programme continues to take place, utilising the £500,000 Health Foundation grant.
The programme is a key part of our 2016/17 business plan with a target to ensure every trust within the region is engaged with the programme.
Find out more
Visit the Yorkshire & Humber AHSN website.
Contact for help and advice
Shaun Lockwood, Communications Manager YHAHSN
Programme duration: Ongoing