Variation in ambulance call rates for care homes in Torbay, UK

Abstract

Emergency ambulance calls represent one of the routes of emergency hospital admissions from care homes. We aimed to describe the pattern of ambulance call rates from care homes and identify factors predicting those homes calling for an ambulance most frequently. We obtained data from South Western Ambulance Service NHS Foundation Trust on 3138 ambulance calls relating to people aged 65 and over from care homes in the Torbay region between 1 April 2012 and 31 July 2013. We supplemented this with data from the Care Quality Commission (CQC) website on home characteristics and outcomes of CQC inspections. We used descriptive statistics to identify variation in ambulance call rates for residential and nursing homes and fitted negative binomial regression models to determine if call rates were predicted by home type (nursing versus residential), the five standards in the CQC reports, dementia care status or travel time to hospital. One hundred and forty‐six homes (119 residential and 27 nursing) were included in the analysis. The number of calls made ranged from 1 to 99. The median number (IQR; range) of calls per resident per year was 0.51 (0.21–0.89; 0.03–2.45). Nursing homes had a lower call rate than residential homes [adjusted rate ratio (ARR) 0.29; 95% CI: 0.22–0.40; P < 0.001]; care homes failing the quality and suitability of management standard had a lower call rate compared to those who passed (ARR 0.67; 95% CI: 0.50–0.90; P = 0.006); and homes specialising in dementia had a higher call rate compared to those not specialising (ARR 1.56; 95% CI: 1.23–1.96; P < 0.001). These findings require replication in other regions to establish their generalisability and further investigation is required to determine the extent to which call rate variability reflects the different needs of resident populations or differences in care home policies and practice.

Using advance and emergency care plans during transfer decisions: A grounded theory interview study with care home staff

“…Residents' rates of secondary care use are variable and influenced by multiple factors: 6 the majority of hospital use is attributable to less than half of all residents 7 and marked variation in acute emergency care use has been observed between residents from different care homes, even when the demographic and health profiles of residents are similar. [8][9][10] For some care home residents, a hospital admission may offer limited benefit and pose substantial risk of physical and cognitive complications, 11 with residents experiencing higher in-patient mortality than community dwelling older people. 12 Although often associated with deteriorating health, advance care planning (ACP) can be done at any stage to ensure that a person receives medical care that aligns with their wishes, goals and preferences.…”

Effect on secondary care of providing enhanced support to residential and nursing home residents: a subgroup analysis of a retrospective matched cohort study

“…For example, medication administration errors may be less likely among nursing homes 61. Residential care home residents may have higher ambulance call rates62 and higher emergency admission rates63 than nursing home residents. There are indications that GPs visit nursing home more regularly than residential care homes43 64 and that nursing homes are more likely than residential care homes to have an aligned general practice and to pay a general practice to provide services,65 even though residential care home residents may also have needs requiring healthcare support 43 52…”

Variations in older people’s emergency care use by social care setting: a systematic review of international evidence

“…Previous research has suggested that the presence of registered nurses within a social care setting can moderate ambulance call rates and hospital admissions. 25 , 36 , 37 Recent research demonstrated that people with dementia in the last year of their life, who live in a local authority with more nursing home beds, have fewer visits to the Emergency Department than people living in local authorities with a lower number of nursing home beds. 38 Our review suggests that emergency hospital attendances are lower in nursing homes in comparison with other care settings, including residential homes, 7 assisted living facilities 26 and home care services.…”