Fall patients' care 'unacceptable'

Senior doctors and health campaigners called for improved care and prevention after the report found most local health services were "nowhere near meeting national standards and guidelines".

The research, commissioned by the Healthcare Commission and carried out by the Royal College Of Physicians' Clinical Effectiveness and Evaluation Unit (CEEU), was carried out in 157 primary care trusts (PCTs) across England, Wales and Northern Ireland.

The first national clinical audit to investigate patient falls found that 80% of people with hip fractures spent more than two hours in accident and emergency departments before being transferred to a suitable ward.

Some 31% of operations for hip fracture were delayed beyond the 48-hour target, despite delay being associated with increased mortality, while 29% of hip operations were delayed due to organisational issues.

Less than a third of patients had a pre-operative medical review by a suitably trained physician, the report found, and most patients returning home from A&E after a fragility fracture were not offered a falls risk assessment, while only 22% were referred for exercise training to reduce future falls.

Three months after sustaining the fracture, only a fifth of these patients were on appropriate treatment for osteoporosis, according to the report, which added that even after surgery for the most severe fragility fracture, the hip, less than 50% were on appropriate osteoporosis treatment.

In only one in 10 cases did the patient's notes reveal they had been given information on how to prevent further falls.

The report recommended that PCTs should ensure they offer prompt surgery for patients with hip fractures, and consider commissioning falls clinics to improve risk assessments and treatment.

There should also be more therapeutic exercise options available locally in collaboration with local authorities, the report said.