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Related Experiment Video

Updated: Jul 14, 2026

Bedside Ultrasound for Guiding Fluid Removal in Patients with Pulmonary Edema: The Reverse-FALLS Protocol

Bedside Ultrasound for Guiding Fluid Removal in Patients with Pulmonary Edema: The Reverse-FALLS Protocol

Published on: July 28, 2018

Introducing a clinical pathway in fluid management.

Jennifer Davidson¹, Richard Griffin, Simon Higgs

¹St Mary's Hospital, Paddington.

Journal of Perioperative Practice

|June 30, 2007

Summary

A clinical pathway for elderly patients with fractured neck of femur significantly improved fluid management. This led to reduced perioperative hypotension and increased intravenous fluid administration.

Area of Science:

Geriatric Medicine
Surgical Patient Management
Clinical Pathway Development

Background:

The National Confidential Enquiry into Perioperative Death's (NCEPOD) 1999 report highlighted critical care gaps for elderly patients with fractured neck of femur (NOF).
Recommendations focused on improving management for patients admitted via Accident and Emergency (A&E) with NOF, particularly concerning fluid management.

Purpose of the Study:

To audit and improve fluid management in elderly patients with fractured NOF.
To assess the impact of a multidisciplinary clinical pathway on patient outcomes.

Main Methods:

An initial audit of fluid management in elderly patients with fractured NOF was conducted.
A multidisciplinary clinical pathway was developed and implemented.

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Published on: November 9, 2016

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Bedside Ultrasound for Guiding Fluid Removal in Patients with Pulmonary Edema: The Reverse-FALLS Protocol

Bedside Ultrasound for Guiding Fluid Removal in Patients with Pulmonary Edema: The Reverse-FALLS Protocol

Published on: July 28, 2018

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

Published on: November 9, 2016

The audit was repeated in 2002, 2003, and 2005 to evaluate the pathway's effectiveness.

Main Results:

Significant reductions in the incidence of perioperative hypotension were observed between 2000 and 2005.
A notable increase in the percentage of patients prescribed and receiving intravenous fluids was recorded (p<0.05).

Conclusions:

A protocol-based clinical pathway, stemming from NCEPOD recommendations, substantially enhanced fluid management for patients with fractured NOF.
The implemented pathway demonstrated a positive impact on perioperative care for this patient group.