Predictors of conveyance of care home residents to hospital by ambulance services for medical emergencies

Conference:

SAPC ASM 2023 - Brighton

Talk Code:

2D.8

Presenter:

Aloysius Siriwardena

Twitter:

@nsiriwardena

Co-authors:

Aloysius Niroshan Siriwardena, Vanessa Botan, Graham Law, Despina Laparidou, Viet-Hai Phung, Ffion Curtis, Gregory Whitley, Joseph Akanuwe, Elise Rowan; Rachael Fothergill, Tracy McCranor, Susan Bowler, Maria Kordowicz, Nicoya Palastanga, Lissie Wilkins, Robert Spaight, Elizabeth Miller, Adam Gordon

Author institutions:

University of Lincoln, East Midlands Ambulance Service NHS Trust, Lincolnshire Partnership NHS Foundation Trust, University of Leicester, University of Nottingham

Problem

Residents of care homes may be affected by medical emergencies, resulting in ambulance attendance and conveyance to hospital which add extra pressure and costs to an already strained emergency and healthcare system. The aim of this study was to determine the factors predicting care home resident conveyance to hospital by ambulance services.

Approach

We used a cross-sectional study design analysing routine data from electronic clinical records from East Midlands Ambulance Service NHS Trust (EMAS) from 2018 to 2021. A multivariable multinominal regression model was used to identify the main predictors of conveyance to hospital or referral to community services.

Findings

The data included 170,612 attendances to care homes representing 7.5% of the total number of EMAS attendances between 2018-2021. The main predictors of conveyance to hospital were being male (Relative Risk Ratio [RRR] 1.07, 95% Confidence Interval [CI] 1.03-1.10, p<0.001), aged 70-79 years (RRR 1.09, 95%CI 1.03-1.17, p<0.001) or 80-89 years (RRR 1.10, 95%CI 1.03-1.17, p<0.001), situated in an area of higher deprivation (RRR 1.06, 95%CI 1.03-1.09, p<0.001), or having dispatch categories which included cardiovascular (RRR 11.29, 95%CI 10.43-12.22, p<0,001), trauma such as falls (RRR 9.50, 95%CI 8.97-10.05, p<0,001) or neurological conditions (RRR 9.06, 95%CI 8.42-9.75, p<0,001). Calls made to ambulance services on behalf of care home residents by health care professionals (HCPs) (RRR 15.37, 95%CI 13.41-17.62, p<0,001) or where they had a higher National Early Warning Score (NEWS2) (RRR 1.23, 95%CI 1.22-1.24, p<0,001) resulted in significantly higher rates of conveyance.

Consequences

A series of factors significantly predict conveyance of care home residents to hospital by ambulance. These include HCP referral and a higher NEWS2 score confirming that the severity of the clinical condition of the patient significantly increased conveyance. Future interventions to prevent or address certain acute conditions such as falls or provide enhanced care for long term conditions in care homes may prevent some emergencies or reduce the risk of conveyance to hospital.

Submitted by:

Aloysius Siriwardena

Funding acknowledgement:

This abstract presents independent research commissioned by NIHR ARC East Midlands. The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the funder.