Falls
Feature consisting of multiple components that all aim to mitigate the risk factors for falling identified by a person ’ s individual assessment .
One way to deliver multifactorial falls prevention to high-risk patients is via an outpatient clinic dedicated to falls prevention . One such clinic setting is the Older Person Assessment Unit ( OPAU ) Falls Clinic at Guys Hospital .
As physical attendance at outpatient clinics put patients at risk of spreading COVID-19 , the OPAU Falls Clinic had to consider an alternative , identifying virtual telephone consultations as an important way for patients to access their care without this risk .
Consequently , a ‘ COVID Falls Pathway ’ emerged , which for the most part remains in practice today .
The new pathway
Our falls clinic receives referrals from various sources , including the Guys and St Thomas ’ NHS internal electronic referral system and multiple community stakeholders , including general practitioners from local boroughs .
Upon receipt , referrals are vetted by the consultant geriatrician and then the administration team books appointments accordingly .
The falls clinic takes place every Wednesday , beginning with a multidisciplinary team meeting , which is led by the consultant geriatrician . Patients are screened beforehand by the occupational therapist and physiotherapists and are discussed at the meeting .
Before the pandemic , the clinic comprised of face-to-face assessments only . During the pandemic , telephone assessments became the primary form of assessment . Now there is a combination of face-to-face and telephone assessments .
The clinical needs and the specific clinician input required by patients is identified during the multidisciplinary team meeting and patients are allocated accordingly .
Telephone assessments
The initial contact with patients takes the form of a telephone consultation , comprising of comprehensive information gathering in a structured interview . These assessments are completed by the consultant , occupational therapist or physiotherapist .
The aim of the initial contact is to obtain a detailed collateral history so as to ascertain the intervention the patient requires , thereby determining if there is a clinical need for face-to-face follow-up in clinic or not .
The initial assessment comprises a detailed falls history , medical history , comprehensive geriatric assessment , social history and questions relating to occupational performance and the home environment .
Initially , the main focus was on triaging , whereby only those individuals requiring face-to-face input were offered the opportunity to do so . This method , however , proved beneficial in the long term .
Patients ’ clinical needs were identified during the telephone consultation , determining whether or not returning for a face-to-face appointment was recommended , and if so , what specific clinical input would be required , thereby also reducing time demands .
There are multiple factors that can affect the effectiveness of a telephone consultation , relating to logistics , the patient and the clinician .
These challenges include , but are not limited to , hearing impairment , cognitive impairment and language barriers
However , with the role of administration staff in completing a call-out list prior to the clinic , we strive to ensure that as many of these potential difficulties are addressed beforehand .
This involves ensuring we have correct contact details , confirming attendance and the organisation of interpreters
Additionally , obtaining collateral from next of kin aids the assessment process involving patients with hearing and / or cognitive impairment .
The final factor at play is the clinician ’ s confidence in their ability and competence to complete the telephone consultation .
Just over half
51 %
of occupational therapists reported learning new skills as a result of the pandemic
60 %
of occupational therapists were providing an alternative method of service delivery due to COVID
April 2022 OTnews 21