Understanding the scale, impact, and care trajectory for patients who experience a long lie after a fall: mixed methods study protocol [version 1; peer review: 1 approved, 1 approved with reservations]

Introduction

Falls are a major public health concern, particularly among older adults. Without life-threatening symptoms, ambulance calls may be triaged as low priority and people may remain on the floor and experience a “long lie”, risking dehydration, pressure injury, muscle damage and psychological distress. However, there is currently limited evidence on the scale, clinical impact and subsequent care trajectory for people who have experienced a long lie. This study aims to address this gap by exploring the characteristics, outcomes, and potential interventions for people who experience a long lie after a fall.

Methods

This is a comprehensive, 27-month, mixed-methods study structured across seven interlinked work packages (WPs). Quantitative work (WP1 & WP2) will analyse linked ambulance, emergency department, and hospital data from one ambulance service region to characterise individuals who experience long lies, quantify their care trajectories, estimate resource use, and explore and refine the definition of a ‘harmful long lie’ threshold. WP3 involves a detailed review of 200 patient hospital notes to understand the mechanisms by which long lies impact health outcomes and care trajectories. Qualitative work (WP4, WP5, & WP6) includes analysis of surveys and semi-structured interviews with ambulance staff, care home managers, key stakeholders, and, crucially, individuals with lived experience of a long lie and their carers. WP7 will synthesize all findings in workshops with national stakeholders to co-produce clear, evidence-based guidance and policy recommendations for managing long lies.

Discussion

By integrating quantitative data on scale and cost of long lies with qualitative data on lived experience and professional practice, this study will provide in-depth understanding of the clinical, social, and economic impact of long lies. The findings will inform the development of interventions to mitigate the harmful effects of prolonged time on the floor leading to improved care pathways and better outcomes for individuals who experience a long lie after a fall.