Community and Health Research Unit, School of Health and Social Care, Lincoln Medical School, University of Lincoln, Lincoln, LN6 7TS, UK.
School of Social Sciences, Nottingham Trent University, Nottingham, NG1 4FQ, UK.
Scand J Trauma Resusc Emerg Med. 2024 Nov 27;32(1):121. doi: 10.1186/s13049-024-01294-y.
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.
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.
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.
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.
与社区居住的老年人相比，养老院居民更容易发生医疗紧急情况，通常需要救护车接送并送往医院。我们旨在确定通过救护车服务预测养老院居民送往医院或转至社区途径的因素。
我们使用回顾性横断面研究设计，分析东米德兰兹救护车服务 NHS 信托基金（EMAS）电子临床记录中的常规数据。数据包括 2018 年至 2021 年期间由救护车照顾的所有患者，包括养老院居民。使用多变量逻辑回归模型来确定送往医院或转至社区服务的主要预测因素。
数据包括 170612 次养老院就诊，占 2018 年至 2021 年期间 EMAS 就诊总数的 7.5%。送往医院的主要预测因素是男性（相对风险比 [RRR] 1.07，95%置信区间 [CI] 1.03-1.10，p<0.001）、年龄在 70-79 岁（RRR 1.09，95%CI 1.03-1.17，p<0.001）或 80-89 岁（RRR 1.10，95%CI 1.03-1.17，p<0.001）、位于贫困程度较高的地区（RRR 1.06，95%CI 1.03-1.09，p<0.001），或具有包括心血管疾病（RRR 11.29，95%CI 10.43-12.22，p<0.001）、跌倒等创伤（RRR 9.50，95%CI 8.97-10.05，p<0.001）或神经疾病（RRR 9.06，95%CI 8.42-9.75，p<0.001）等分类的调度类别。医疗保健专业人员（HCP）拨打的电话（RRR 15.37，95%CI 13.41-17.62，p<0.001）或患者的国家早期预警评分（NEWS2）较高（RRR 1.23，95%CI 1.22-1.24，p<0.001）导致送往医院的比例显著增加。
各种因素显著预测了养老院居民通过救护车送往医院。这包括 HCP 转诊和 NEWS2 评分较高，这证实了患者临床状况的严重程度显著增加了运送。未来的干预措施可以预防或解决某些情况，如跌倒，或在养老院提供增强的护理，以防止或减少送往医院的可能性。
