A qualitative study of ambulance personnel, care staff and service users’ experiences and perceptions of emergency care in care homes

Conference:

SAPC ASM 2023 - Brighton

Talk Code:

2D.5

Presenter:

Despina Laparidou

Twitter:

@DespiLaparidou

Co-authors:

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

Author institutions:

University of Lincoln, University of Leicester, Lincolnshire Partnership NHS Foundation Trust, University of Nottingham, Patient and Public Contributors, East Midlands Ambulance Service NHS Trust

Problem

Medical emergencies in care homes are common and costly, often resulting in calls to emergency services, ambulance attendance, conveyance, and hospital admission. Studies suggest that over half the emergency transfers to hospital from care homes could be prevented with better ongoing care, staff training and access to primary care. Our aim was to explore care home and ambulance staff, resident, and their relatives’ experiences and perceptions of emergencies in care homes.

Approach

We employed a qualitative design. The study involved semi-structured interviews with ambulance staff, care home staff, and family members of care home residents in the East Midlands, UK. Data were analysed thematically using a framework approach.

Findings

We interviewed 15 ambulance staff (including paramedics, technicians, urgent care assistants), four relatives of care home residents and one care home staff member with further interviews currently ongoing. Preliminary analysis showed that although good communication between ambulance, care home and hospital staff was considered vital, experiences were varied. Relatives felt that effective and respectful communication with ambulance and care home staff was also important but sometimes was lacking. The importance of crucial information about residents, ready for ambulance staff upon arrival, was highlighted. Participants emphasised the value of consulting with everyone involved (care home staff, residents, relatives) during the decision-making process, but some relatives felt that they weren’t as involved as they would have liked. Final care decisions were based on the resident and their family’s wishes, medical history, ReSPECT forms, alternative pathways to the Emergency Department, and what participants considered the most appropriate course of action for the resident. Participants also discussed care-home related issues that facilitated or impeded good quality emergency care, such as ease of access/egress, staff numbers and training, policies and procedures, and overall quality of care. Finally, Emergency Medical Services-related factors (e.g., current pressures on the service, better training needed caring for people with dementia, end-of-life care, and having access to an on-call geriatrician), which impacted those who experienced emergencies in care homes, were also considered important.

Consequences

This study highlighted the main structures and processes that facilitated or impeded emergency care in care homes. The findings will inform the development of interventions to improve outcomes and experiences of emergencies in care homes for everyone involved, including care home and ambulance staff, residents, and their relatives.

Submitted by:

Despina Laparidou

Funding acknowledgement:

This project has been funded by NIHR Applied Research Collaboration East Midlands.