Predictors of care home resident conveyance to hospital or referral to community pathways by a regional ambulance service attending medical emergencies: a retrospective cross sectional study

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

Abstract

Background
Care home residents are at higher risk compared with community dwelling elders for medical emergencies, often resulting in ambulance attendance and conveyance to hospital. We aimed to determine the factors predicting care home resident conveyance to hospital or referral to community pathways by an ambulance service.

Methods
We used a retrospective cross-sectional study design analysing routine data from electronic clinical records from East Midlands Ambulance Service NHS Trust (EMAS). Data comprised all patients including care home residents attended by ambulance from 2018 to 2021. A multivariable logistic regression model was used to identify the main predictors of conveyance to hospital or referral to community services.

Results
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 by health care professionals (HCPs) (RRR 15.37, 95%CI 13.41-17.62, p<0,001) or where patients had a higher National Early Warning Score (NEWS2) (RRR 1.23, 95%CI 1.22-1.24, p<0,001) resulted in significantly increased conveyance.

Conclusions
Various factors significantly predicted conveyance of care home residents to hospital by ambulance. These included HCP referrals and a higher NEWS2 scores confirming that severity of clinical condition of the patient significantly increased conveyance. Future interventions to prevent or address certain conditions such as falls or provide enhanced care in care homes may prevent some emergencies or reduce likelihood of conveyance to hospital.

Citation

Siriwardena, A. N., Botan, V., Law, G., Laparidou, D., Phung, V.-H., Curtis, F., Whitley, G. A., Akanuwe, J., Rowan, E., Fothergill, R., Bowler, S., Kordowicz, M., Palastanga, N., Wilkins, L., Spaight, R., Miller, E., & Gordon, A. (2024). Predictors of care home resident conveyance to hospital or referral to community pathways by a regional ambulance service attending medical emergencies: a retrospective cross sectional study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 32(1), Article 121. https://doi.org/10.1186/s13049-024-01294-y

• Journal Article Type: Article
• Acceptance Date: Nov 17, 2024
• Online Publication Date: Nov 27, 2024
• Publication Date: Nov 27, 2024
• Deposit Date: Nov 22, 2024
• Publicly Available Date: Nov 27, 2024
• Journal: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
• Electronic ISSN: 1757-7241
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 32
• Issue: 1
• Article Number: 121
• DOI: https://doi.org/10.1186/s13049-024-01294-y
• Public URL: https://nottingham-repository.worktribe.com/output/42216995
• Publisher URL: https://sjtrem.biomedcentral.com/articles/10.1186/s13049-024-01294-y
• Additional Information: Received: 18 July 2024; Accepted: 17 November 2024; First Online: 27 November 2024; : ; : The study was approved by the NHS Health Research Authority West Midlands - Coventry & Warwickshire Research Ethics Committee (REC reference: 21/WM/0229, Protocol number: 21005, Amendment number: 302213_SA02_10102022, Amendment date: 10 October 2022, IRAS project ID: 302213) for analysis of anonymised data.; : Not applicable.; : The authors declare no competing interests.