St James's Hospital: A new falls and blackout unit at St James's Hospital in Dublin aims to dramatically reduce the often fatal effects of falls by responding with a rapid dedicated assessment and treatment service.
The facility is part of a new centre for ageing, whose director, Prof Rose Anne Kenny, established a similar award-winning clinic in Newcastle-on-Tyne's Royal Victoria Infirmary.
Falls are the leading cause of injury-related visits to Irish A&E departments, and almost half of all hospital visits of the over-65s are the result of a fall. One fall in six leads to injury, with hip fracture being the most serious.
Half of all people suffering a hip fracture never regain their previous level of independence, a quarter die within six months, and almost a quarter are discharged to a nursing home. Also, falls and blackouts can be non-specific presentations of chest problems, kidney infection, heart attack or stroke.
Around 4,500 people presented at St James's Hospital last year because of a fall or a blackout. Up to now, in common with other A&E responses countrywide, such patients were assessed for fall-related injury only. "It was a case of X-ray, suturing, that's it, with little opportunity to ask important questions regarding underlying causes," says Prof Kenny, a professor in cardiovascular medicine.
Now a new multidisciplinary team, with access to local and national community, will assess the patient comprehensively. Team members include consultant physicians, nurse specialists, physiotherapists and occupational therapists trained in falls, blackouts and osteoporosis management. The unit has specialist equipment for monitoring low blood pressure states, abnormal heart rhythms, gait, balance and bone strength.
The centralised one-stop service is the first of its kind in the country. Patients will be seen promptly. All investigations and treatment prescriptions will take place during their first visit, thus reducing repeat trips. While the service is currently limited to business hours, Prof Kenny says that 85 per cent of falls cases present in daylight hours. Any patients admitted overnight will be seen by the team the next morning.
The new service is co-funded by the Department of Health and Children and the American trust Atlantic Philanthropies, founded by Charles 'Chuck' Feeney.
"The falls and blackout unit is right beside casualty. We estimate we will assess six to 10 people per day, with full investigation and treatment of symptoms and causes. Is their living environment safe, for example?" says Prof Kenny. "We will be liaising back into the community with our staff working in local health centres and nursing homes, and their staff coming into the hospital," she says.
She hopes the clinic will offer a model to be replicated elsewhere.
"We are in discussion with the Department of Health and Children to develop a Centre of Excellence for Successful Ageing. We will function as a model for service delivery for teaching and training, focusing on key areas of age-related disorders. Ideally, we will facilitate the delivery of high quality care nationally to older people in the community, in nursing homes and in acute hospitals," she says.