An analysis of 2024 inpatient falls audit data and reflection on six years as a continuous audit

In 2024, 1,894 people sustained a femoral fracture as an inpatient; 1,628 (86%) were due to a fall and included as cases in the National Audit of Inpatient Falls (NAIF). One in seven people who fracture their hip as a hospital inpatient will die within 30 days, 30% within a year; fewer than half will return to their usual residence.

Of particular note in the National Audit of Inpatient Falls Annual Report 2025 is the data on post-fall management:

• Actions taken after a fall have the potential to influence outcomes and patient experience. If a post-fall check indicates that there may be a femoral fracture, this should initiate the use of flat lifting techniques, rapid access to pain relief, and prompt diagnosis and management of the fracture. KPIs 2, 3 and 4 relate to NICE quality standard 86, statements 4, 5 and 6.  KPI 2 – Check for injury before moving and injury suspected – has changed in this report and now reports on the proportion of patients who were checked for an injury and where injury was suspected. As all patients in this audit had a femoral fracture, this figure should be 100%, however, just over half (54%) of patients had a documented post-fall check which indicated the patient had an injury; this  has not changed significantly in the last three years.
• In 63% of cases, severe harm was attributed to the fall that caused the fracture (a further 1.6% were recorded as death). This has continued to drop since a peak of 78% in 2021.
• Pain relief after the fracture -  in 2024, with a quarter of the patients in the audit (28%) received pain relief within 30 minutes of the IFF compared to 26% in 2023. Overall, 77% of patients were administered analgesia after the fall that caused the IFF and the median time to administration was 1 hour and 19 minutes after the fall

The report makes a number of proposals and recommendations, including:

• Where injury is suspected, effective checks should aim to improve the quality of the check to quickly identify those who may need analgesia. A further factor delaying analgesia may be the time taken to arrange and complete the post-fall medical assessment. Trusts should look at implementing practices that expedite analgesia provision. For example, a review of pain and prescribing could be prioritised once the primary survey is completed. Additionally, those handing over information for the post-fall medical assessment should emphasise analgesia requirements in their SBAR and advocate for their patient when the assessment is underway.
• ICBs and health boards should guarantee that severe harm is always attributed to inpatient fall-related hip fractures. Over the past two years, there has been a reduction in the proportion of patients with hip fracture where harm was classified as severe, from 78% in 2021 to 63% in 2024. NAIF recommends using the approach adopted by NHS England of attributing severe harm to all femoral fractures sustained in hospital but is clear that there has been a change of practice with respect to this. It is clear that there has been some misunderstanding of the Patient Safety Incident Response Framework (PSIRF). While PSIRF recommends not necessarily pursuing full reviews of every fall related femoral fracture but taking a more nuanced approach to learning from incidents, the severity of the harm the patient has experienced should still be correctly attributed in incident reporting.

Note: This is the final National Audit of Inpatient Falls (NAIF) report from the continuous audit of only those inpatients who had a fall resulting in a femoral fracture. In January 2025, NAIF expanded to collect data on all fractures, head injuries and spinal injuries that occurred as a result of an inpatient fall and therefore the next report will present national data on patients with all these fall-related injuries.