An Audit Of Falls Admissions Documentation To A University Hospital: Cycle 1

Abstract Background 30% of adults aged 65 years and older experience a fall annually which can result in significant disability. The World Falls Guidelines (WFG) 2022 were developed to guide non-specialist clinicians in undertaking a falls assessment for high vs low/medium risk of further fall. Methods The medical admission list from July 2023-October 2023 was reviewed and 165 charts were requested for admissions listed as “fall’, ‘syncope’, ‘collapse’ and ‘pre-syncope’. Of 93 charts reviewed, 60 admissions were included in the audit. Of the 26 criteria listed in the WFG 2022, 10 were included in this audit. The index admission document was assessed for documentation of demographics, description of fall, any falls in preceding year, documentation of syncope, documentation of injury, cardiac and neuro examination, walking aids, comment on the cause of fall, medication review and time to mobility assessment. A pre-morbid Rockwood Clinical Frailty Score (CFS) was assigned on chart review. Results 40% were male and 60% were female. Mean age of patients was 80.25 years (SD=8.4) with a mean CFS of 3.6 (SD=1.89). 91.7% documented some descriptor of the fall, 50% documented asking about syncope, 33.3% documented asking about previous falls. 96.7% had a documented cardiac exam, while only 71.1% documented a neuro exam and 41,7% documenting mobility baseline. 60% had a medication review documented and 41.6% had mobility assessed in under 72 hours. Only 76.7% of admissions had a documented differential for the fall. Conclusion Further education is required to adequately risk stratify patients admitted with falls and help guide appropriate investigation and workup as well as promote thorough documentation. An education session was conducted with Medical SHOs on May 14th, 2024, and Cycle 2 of the audit will commence June 2024.