A qualitative study of the determinants of adherence to NICE falls guideline in managing older fallers attending an Emergency Department.
Background: The National Institute for Health and Care Excellence (NICE) 2004 Falls guideline was developed to
improve the assessment and management of falls and prevention of future falls. However, adherence to the
guideline can be poor. As emergency departments (EDs) are usually consulted by older adults (aged 65 and over)
who experience a fall, they provide a setting in which assessments can be conducted or referrals made to more
The objective of this study was to investigate how falls are managed in EDs, reasons why guideline
recommendations are not always followed, and what happens instead.
Methods: The study involved two EDs. We undertook 27 episodes of observation of healthcare professional
interactions with patients aged 65 or over presenting with a fall, supported by review of the clinical records
of these interactions, and subsequently, 30 interviews with healthcare professionals. The qualitative analysis
used the framework approach.
Results: Various barriers and enablers (i.e. determinants of practice) influenced adherence at both EDs, including the
following: support from senior staff; education; cross-boundary care; definition of falls; communication; organisational
factors; and staffing.
Conclusions: A variety of factors influence adherence to the Falls guideline within an ED, and it may be difficult to
address all of them simultaneously. Simple interventions such as education and pro-formas are unlikely to
have substantial effects alone. However, taking advantage of the influence of senior staff on juniors could
enhance adherence. In addition, collaborative care with other NHS services offers a potential approach for
emergency practitioners to play a part in managing and preventing falls.
We thank Collaboration for Leadership in Applied Health Research and Care-Leicestershire, Northamptonshire and Rutland (CLAHRC-LNR) for funding the research PhD studentship. Please note the views are the authors’ and not the CLAHRC’s, nor those of the NIHR or the Department of Health.
CitationMcEwan, H., Baker, R., Armstrong, N. et al. A qualitative study of the determinants of adherence to NICE falls guideline in managing older fallers attending an emergency department. Int J Emerg Med 11, 33 (2018). https://doi.org/10.1186/s12245-018-0192-9
Author affiliation/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Health Sciences
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