• Aloysius Niroshan Siriwardena, Vanessa Botan, Graham Law, Despina Laparidou, Viet-Hai Phung, Ffion Curtis, Gregory Adam Whitley, Joseph Akanuwe, Elise Rowan, Rachael Fothergill, Susan Bowler, Maria Kordowicz, Nicoya Palastanga, Lissie Wilkins, Robert Spaight, Elizabeth Miller, and Adam Gordon.
• Community and Health Research Unit, School of Health and Social Care, Lincoln Medical School, University of Lincoln, Lincoln, LN6 7TS, UK. nsiriwardena@lincoln.ac.uk.
• Scand J Trauma Resus. 2024 Nov 27; 32 (1): 121121.

BackgroundCare 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.MethodsWe 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.ResultsData 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.ConclusionsVarious 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.© 2024. The Author(s).

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