Abstract
Introduction:
Inpatient falls are the most common adverse patient safety incidents in hospitals in the UK. The assessment and management following an inpatient fall is often the responsibility of the most junior doctor on call, particularly out of hours. Frequently, there are key omissions in the assessment of these patients, leading to missed diagnoses, poor management and avoidable patient harm. This study aimed to improve the knowledge and confidence of foundation doctors in the assessment and management of inpatient falls.
Method:
31 patients were identified who had suffered ‘severe harm’ following an inpatient fall and a retrospective review of their notes was performed. A preliminary survey on self-perceived confidence levels on different areas of the assessment and management of inpatient falls was distributed to all foundation doctors at Ipswich Hospital. The key themes of the simulation scenario were subsequently determined by the areas of weakness identified in both the survey and documentation review. A total of 9 foundation doctors at Ipswich Hospital participated in a high-fidelity inpatient fall simulation with a patient actor. Pre- and post-simulation knowledge and confidence surveys consisting of ten multiple choice questions and Likert scales respectively were distributed using QR codes.
Results:
Post-simulation confidence levels improved in all domains measured (p < 0.05) with an overall increase in average confidence levels from 3.3/5.0 to 4.3/5.0 (p=0.007). Average post-simulation knowledge score increased from 4.6/10 to 7.4/10 (p= 0.01). Domains in which the greatest improvements in knowledge and confidence were seen included: moving & handling, neurological observations, assessment of suspected hip fractures and escalating concerns.
Conclusion:
The use of simulated patients improves the knowledge and confidence of foundation doctors in the assessment and management of inpatient falls. The pilot project is due to be expanded with plans to incorporate this simulation scenario into the local foundation teaching programme.
Comments
Question
Hello. Thank you for presenting your work on improving confidence of foundation doctors performing post-fall checks. Have you considered measuring the time taken to perform a post-fall check and how complete it was before and after the training? What will the Falls talk address that is not covered in the simulation sessions? And how long does a simulation session take and for how many foundation doctors in each session?
Thank you for your questions.
With regards to time taken to perform a post-fall check, this is not something we have looked at within this cycle of the improvement project, but is certainly something we can look at for future cycles. As this was an initial pilot project, the simulation is yet to be delivered to all foundation doctors. The degree of comprehensiveness of the post-fall assessment, in line with the NAIF post-fall check guidance, is definitely a key area we hope to look at upon analysing post-fall documentation once all foundation doctors have received the teaching. We then plan to subsequently compare this to the initial data we collected prior to the teaching being introduced.
For the falls talk, we are aware that doctors receive a lot of information during their induction programme and we were cautious about overwhelming them with information. The main purpose of the talk was to signpost doctors to the Trust resources which are available to aid them in the assessment and management of an inpatient fall such as the intranet page, post-falls flow chart and specific Trust guidelines. Foundation doctors will then partake in the simulation and receive a separate more comprehensive falls talk as part of the local foundation teaching programme within their first few months.
In response to your final question, the simulation scenario itself lasted approximately 20 minutes and was divided into two main parts (assessment and management) with two foundation doctors partaking in each part allowing four doctors to take part in each simulation. With expansion of the project, the scenario is planned to be incorporated within the local 'Simulation Day' which every foundation doctor has during their clinical year and is delivered to groups of 6-8. With multiple scenarios delivered during the day, not all doctors will be able to actively take part in this particular scenario. However, all doctors will be able to engage in the scenario by watching live events in a separate seminar room and through active participation in the debrief.