Researching Emergency Ambulance calls to Care Homes (REACH)
Why the research is needed?
The research is needed because we need to better understand how to improve the management, outcomes and experiences of residents and others involved in medical emergencies in care homes.
What is already known about the subject?
We know that medical emergencies in residential or nursing care homes are common and costly, often result in calls to emergency services, ambulance attendance, conveyance, and admission to hospital. There are at least 30 transfers for every 100 residents from residential care to Emergency Departments each year, of which around half result in admission to hospital. It is thought that over half of emergency transfers to hospital could be prevented with better ongoing care, access to primary care and training of staff. With the current COVID-19 pandemic there have been additional pressures which will have had further impact on this problem, and this also warrants investigation.
Who we are working with?
Academics from the Universities of Lincoln and Leicester are working with East Midlands Ambulance Service NHS Trust (EMAS), care homes and our patient group to develop and conduct this study.
How are patients and the public involved?
We have involved patients and the public through the Healthier Ageing Patient and Public Involvement (HAPPI) Group. The HAPPI group met to discuss the study on 16 February 2021, strongly supporting the study and recommending we review care home policies and interview ambulance as well as care home personnel. They were also involved in a previous small-scale NIHR East Midlands CLAHRC funded study investigating Diabetes Emergencies in Care Homes (DEICH) which reported in 2019. Two members of the HAPPI group (Nicoya Palastanga and Lissie Wilkins) have agreed to join the study steering group as public contributors and other members will form a reference groups helping with study design, materials, conduct and dissemination.
What we will do?
We will systematically review the literature on this topic, survey care homes and review their protocols. In addition, we will analyse routine data from the regional ambulance service and care homes in the East Midlands, interview residents or relatives, care home and ambulance staff, develop recommendations for improvement and prioritise according to which are likely to be implemented.
What the benefits will be?
The study will provide recommendations that can be adopted by care homes in the region and nationally which have been shown or are likely to improve emergency care.
When the findings will be available?
The findings will be available on completion of the study at the end of two years (expected 2023).
How we are planning for implementation?
We will communicate the recommendations widely to care homes, ambulance services, commissioners, patient groups, public health departments, and the Care Quality Commission. We will provide recommendations to East Midlands Ambulance Service NHS Trust and care homes through the East Midlands Network for Research in Care Homes (ENRICH). In a future impact study beyond the project, we will work with homes to see which recommendations have been implemented.
Professor Niro Siriwardena