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03 Home truths and long lies? Ambulance calls to fallen patients in residential care facilities within an English clinical commissioning group
  1. Josh Miller,
  2. Andrew Barlow,
  3. Vivek Khashu
  1. West Midlands Ambulance Service University NHS Foundation Trust, UK


Background Fallen patients who remain immobile for prolonged periods are at risk of rhabdomyolysis and pressure ulcers. Local factors such as training, equipment, and policies may impact whether residential care staff call emergency services for the fallen patient, rather than residential staff managing their care.

Methods We used routine computer-aided dispatch data within one urban Clinical Commissioning Group (CCG), during the period 1st April 2021 to 31st October 2021, identifying all falls attended by ambulance at nursing, care or residential facilities. We used the percentage of fallen patients not conveyed to hospital as a proxy measure suggesting that homes were calling ambulance services for patients who may only have needed assistance from the floor, while recognising that there are other reasons why patients may have ambulance attendance and not be transported.

Results Within the CCG, there were 763 ambulance attendances for falls in nursing, care or residential facilities within the seven-month period, with a median response time of 87 minutes (IQR 28-207). 315 (41%) of these calls were non-conveyances. The calls came from 126 homes across the CCG, which demonstrated marked variation from 35 (28%) having no non-conveyed falls, through to 11 (9%) having only non-conveyed falls – no patients taken to hospital. We identified 17 homes who had both high rates of non-conveyed falls and high overall rates of fallers (top quintile for each), and shared this with the relevant CCG, who found that local factors such as ‘no-lift’ policies and lack of equipment do exist at some of these sites.

Conclusions Fallen patients in residential homes experience long waits for ambulance care, but two-fifths of these patients receive no onward hospital transport. A low-burden query of routine data identified a group of care homes where initiatives around training, equipment and policies might improve the care of these patients.

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