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BackgroundMedical emergencies in residential or nursing care homes are common and costly, resulting in ambulance attendance and hospitalisation, with extra pressure on an emergency system severely impacted by the Covid-19 pandemic. The aim of this study was to explore how the number of ambulance attendances to care homes varied before and during Covid-19 pandemic whilst considering the UK national lockdowns.MethodsWe 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. An interrupted-time series analysis (ITSA) was used to compare the total number of ambulance attendances to care homes per week before and during the pandemic whilst considering the three UK national lockdown periods. Seasonality (i.e., month of the year), call category, deprivation, and rurality were included as covariates in the model.ResultsThe interrupted time series analysis indicated a significant decrease of 9.9 ambulance attendances to 1956 East Midlands care homes per week during the first lockdown relative to the pre-pandemic period (CI: -19.1, -0.8, p=0.034). This was followed by a significant increase of 13.7 attendances per week in the period between the first two lockdowns (CI: 4.0, 23.5, p=0.006) relative to the first lockdown period. There was no significant change during the second lockdown but there was a significant decrease of 19.7 attendances per week in the third lockdown (CI: -30.5, -9.0, p<0.001) compared to the non-lockdown period preceding it.ConclusionAmbulance attendances to care homes decreased during the Covid-19 pandemic, were significantly reduced in the first and third lockdowns, and remained lower during the pandemic compared to pre-pandemic levels. Further research is needed to investigate the factors that might have influenced this trend including changes in ambulance service policies, ambulance and care home personnel, and increased death rates in care homes.

BackgroundResidents of care homes may be affected by medical emergencies, resulting in ambulance attendance and conveyance to hospital which add extra pressure and costs on an already strained emergency and healthcare system. The aim of this study was to determine the factors predicting conveyance to hospital of care home residents by ambulance services.MethodsWe 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.ResultsThe 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 including falls (RRR 9.50, 95%CI 8.97-10.05, p<0,001) or neurological (RRR 9.06, 95%CI 8.42-9.75, p<0,001) conditions. 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.ConclusionA series of factors significantly predict conveyance to hospital by ambulance of home care residents. These include HCP referral or NEWS2 confirming that the severity of clinical condition of the patient was associated with 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 risk of conveyance to hospital.

BackgroundMedical emergencies in care homes are common and costly, often resulting in calls to emergency services, ambulance attendance, conveyance, and hospital admissions. Over half of emergency transfers to hospital could be prevented with better ongoing care, access to primary care and training of staff. Our aim was to explore ambulance staff experiences of emergencies in care homes.MethodsWe employed a qualitative design. The study involved semi-structured interviews with ambulance staff working at the East Midlands Ambulance Service NHS Trust. Data were analysed thematically using a framework approach.ResultsWe interviewed 15 ambulance staff (including paramedics, technicians, urgent care assistants). Preliminary analysis showed that although good communication with care home staff was considered important, experiences were varied. The importance of good, adequate resident information ready for ambulance staff upon arrival was highlighted. Regarding the decision-making process, participants reported consulting with everyone involved (care home staff, residents, relatives) and making final decisions based on various factors, including the resident/their family’s wishes, medical history, ReSPECT forms, alternative pathways to A&E, and what they considered the most appropriate course of action for the resident. Care home-related factors (access/egress issues; staff training; policies and procedures; and overall quality of care) and Emergency Medical Services-related factors (current pressures on the service; better training needed on working with people with dementia, end-of-life care, etc.; having access to an on-call geriatrician), which impact those who experience emergencies in care homes, were also discussed.ConclusionThis study highlights the main challenges and facilitators that ambulance staff are faced with when dealing with emergencies in care homes. These data present findings of one staff group and triangulation with care home staff, resident and family perspectives would generate further insights. The findings will inform the development of interventions to improve outcomes and experiences of emergencies in care homes.