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.

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 and 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 referral and a higher NEWS2 score 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 the likelihood of conveyance to hospital.