Falls Response: Reducing Harm by Empowering Domiciliary and Care Home Staff
Swansea Bay University Health Board
Introduction:
Older people in community care settings often experienced long waits after falls - “long lies” - leading to serious health deterioration, hospitalisation, and loss of independence. Existing policy mandated 999 calls for all falls, regardless of injury, causing system strain, delayed responses, and poor patient outcomes. This project aimed to reduce long lies by 50% within 12 months by empowering care staff to respond safely and quickly.
Methods:
Using the Model for Improvement and PDSA cycles, the team tested safe, timely falls response models with care providers. Staff were trained to use the iStumble digital decision tool and lifting equipment. A Falls Response Steering Group with health, social care, ambulance, and digital partners guided governance, data review, and scale-up. Three training formats - in-person, online, and blended - were evaluated for reach and effectiveness.
Outcomes:
The project exceeded its aim:
- Ambulance callouts reduced from 100% to 20%
- Hospital conveyance dropped from 60% to 8%
- Average time on the floor fell from 160 minutes to 30 minutes
- Over 600 falls were managed safely
- Staff reported increased confidence and autonomy
- Patients felt safer and more dignified
System benefits included reduced pressure on emergency services, lower hospital admissions, and improved service continuity for care providers.
Learnings:
Success relied on co-producing solutions with staff, tailoring implementation to different provider contexts, and building trust through clear governance. Flexibility in training and real-time data were key. Early staff buy-in and use of real-life scenarios built confidence. If starting again, earlier investment in digital infrastructure would enhance efficiency and feedback.
What Next?
The model will be scaled across Swansea Bay and beyond, with a central training hub, enhanced digital tools, and deeper integration with therapy teams. National adoption is being explored, as the model aligns with strategic goals of avoiding admissions, supporting independence, and delivering sustainable, community-based care.
