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10 September 2022

Care home residency and its association with key outcomes in the ambulance setting: a cross-sectional observational study

David Sinclair , Newcastle University , United Kingdom

Karl Charlton, North East Ambulance Service
Daniel Stow, Queen Mary University of London
Barbara Hanratty, Newcastle University

Abstract

Background: Older people make more calls to the ambulance service than other age groups, and demand is expected to increase as populations age. Care home residents often have complex needs, but little is known about how this impacts ambulance service workload.

Objectives: This study aimed to quantify the workload of ambulance paramedics associated with callouts to care homes, compared to callouts to private households.

Methods: This was an observational study using routine ambulance service data and Rockwood Clinical Frailty Scale scores from North East Ambulance Service (England) patients aged 50+ attended by 100 study paramedics between 1 January 2021 and 30 June 2021. This study used two outcome measures of ambulance workload: time spent at scene, and hospital conveyance. The relationship between care home residency and conveyance to hospital was investigated using ordinal logistic regression. The association between care home residency and paramedic time-at-scene was studied with quantile regression. Covariates included in all analyses were age, gender, whether the call was in core hours (9am-5pm) and three measures of patients' status: frailty (Clinical Frailty Scale), National Early Warning Scores (NEWS2), and ambulance response category. To address potential sampling imbalance, all models were weighted using inverse probability weights (calculated from anonymised emergency call logs containing all potentially eligible callouts).

Results: 3,056 callouts were observed, with 11.4% [95% Confidence Interval: 10.3-12.5] made to care homes. Care home residents were more frail (mean CFS 6.1 [95% CI:5.9-6.3]) than people living in the community (mean CFS 4.7 [95% CI:4.6-4.8]). After adjusting for covariates, care home residents were less likely to be conveyed to hospital (odds ratio: 0.72 [0.56-0.92]) and required similar time-at-scene as other people attended in the community (-2.1 [-6.2 to 2.0] minutes).

Conclusions: Care home residents were less likely to be conveyed to hospital by paramedics while requiring no extra time-at-scene. Our results suggests that care homes contribute towards the safe discharge of patients at scene, providing an appropriate level of care that may otherwise be placed on "downstream' services in secondary care. Enhanced community provision of care may help address this imbalance between patients in private households and in care homes. Care home residents comprise a significant minority of ambulance patients, but are seldom studied. Improving future data collection is essential to understand how to optimise their use of ambulance services.


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