Inpatient Falls audit expands beyond hip fracture, helping to build a fuller picture of care

28 Oct 2026

The latest National Audit of Inpatient Falls (NAIF) report published by HQIP includes inpatient fall-related injuries beyond hip fractures, examining both preventative care before a fall and the quality of care provided afterwards. It found that patients who fall in hospital and suffer injuries such as pelvic fractures, spinal injuries or head trauma are receiving inconsistent post-fall care, with improvement needed in relation to delirium screening and pain relief. 

This is the first NAIF report to move beyond hip fractures, following a switch to direct data entry that allowed the audit to capture the fuller range of injuries patients sustain from inpatient falls, including head injuries, pelvic ring fractures, spinal injuries and rib fractures. In 2025, 4,191 eligible cases were reported by 169 trusts and 7 health boards across England and Wales. Hip fractures remained the most commonly reported single injury (35%), followed closely by head injuries (22%). 

We are encouraged by this year’s expanded response from services across England and Wales which has provided greater insight into inpatient falls, helping us to better understand where care is working well and where improvements are needed” Dr Sunil Nedungayil, senior clinical lead for the Falls Fragility Fracture Audit Programme  

The new NAIF report sets out several key findings: 

• Strong engagement with the expanded audit: The transition to direct data entry and wider case ascertainment has been well supported by services across England and Wales. In the first year of capturing a broader range of injuries beyond hip fracture, 169 trusts and 7 health boards submitted 4,191 cases, demonstrating reassuring levels of participation and a positive response to the audit’s expansion.  
• Post-fall injury checks and medical examinations are sometimes ineffective: Although every case in the audit involved a confirmed injury, no injury was suspected in 47% of post-fall injury checks and 15% of medical examinations, pointing to significant gaps in how effectively these assessments are being carried out. 
• Pain relief after a fall is too slow: A new indicator introduced in this report found only 39% of patients received analgesia within 30 minutes of their fall, with those who were prescribed pain relief waiting a median of 50 minutes. 
• Care might be worse for some injury types: The first year of data suggests patients with pelvic ring, vertebral and rib fractures may receive poorer post-fall care than those with other injuries. This is a pattern that mirrors findings from the National Hip Fracture Database and the Fracture Liaison Service Database. 
• Delirium screening continues to decline: Despite being a key part of pre-fall assessment, delirium screening rates have fallen for four consecutive years, and only a third of cases (33%) had a high-quality multifactorial assessment to optimise safe activity before the injurious fall. 
• Outdated screening tools are still in use: A facilities audit, the first since 2022, found 14% of organisations still use risk-prediction tools to assess fall risk, despite these no longer being recommended under NICE guideline NG249. 

The NAIF report makes three key recommendations for integrated care boards (ICBs) and Welsh health boards: 

1. Strengthen oversight of participation and case ascertainment across trusts and health boards.
2. Standardise post-fall processes and ensure the workforce is adequately trained in post-fall management. 
3. Ensure effective falls governance, including reviewing local policies against NAIF-recommended practices and phasing out the use of falls risk-prediction tools. 

The National Audit of Inpatient Falls (NAIF) is delivered as part of the Falls and Fragility Fracture Audit Programme (FFFAP) by the Royal College of Physicians (RCP), and commissioned by HQIP on behalf of NHS England, the Welsh government and others. The audit collects data from hospitals across England and Wales to support improvements in the prevention and management of inpatient falls. It is one of several HQIP-commissioned national clinical audits within the FFFAP programme, alongside the National Hip Fracture Database (NHFD) and the Fracture Liaison Service Database (FLS-DB). 

This report highlights the value of these programmes in improving healthcare and, ultimately, improving and saving lives. The data and outputs from this work are an invaluable, publicly available resource that shines a light on where improvements will have the maximum impact; supporting healthcare providers to implement changes that will improve care and outcomes for everyone.   

Read the report in full: Beyond hip fracture – HQIP 

Further information  

• About the Falls and Fragility Fracture Audit (FFFAP), incl National Hip Fracture Database (NHFD) 
• Reports from the Falls and Fragility Fracture Audit (FFFAP), incl National Hip Fracture Database (NHFD)  
• More programmes, reports and resources related to musculoskeletal and rheumatology care