Older people who fall and an emergency ambulance:

1
Older people who fall and an emergency ambulance
risks and opportunities of non-conveyance
Helen A Snooks, Mary Halter, Jacqueline C T
Close, Wai-Yee Cheung, Fionna Moore, Stephen E
Roberts
Introduction A high number of emergency (999)
calls are made for older people who fall, with
many patients not subsequently conveyed to
hospital. The use of falls services has been
promoted for ambulance attended patients. UK
Ambulance crews do not generally have protocols
or training to leave people at home, and referral
systems are rare. However, non-conveyance of
older fallers by ambulance staff is high, but
triage is informal.
Results 2 In the baseline dataset, 86 patients
suffered an adverse event (49.). 229 adverse
events were reported in the 437 patient cases
during the study period (34.6), following
introduction of the assessment tool. 103 serious
adverse events were reported in the 437 patient
cases (23.6). The reduction in adverse event
rate was statistically significant (p
.001). In 78 of cases, it was felt that the use
of the tool led to a correct clinical
decision. In 81 of cases, reviewers felt that
the re-attendance related to the original event.
For those subsequently conveyed to AE, both
reviewers felt that in 73.2 of cases, care could
possibly have been accessed through other
existing routes. Both reviewers felt that more
rapid access to home based intermediate care type
services or rapid access to specialist clinics
would have impacted on the subsequent adverse
event rate. In 94 of cases, both reviewers
felt that application of the tool had led to the
correct conveyance decision. In 67 of cases both
reviewers felt that care could not have been
accessed elsewhere. Reviewers judged that
between 16-32 of cases could be dealt with away
from AE with addition of services such as rapid
family doctor input or home based intermediate
care assessment. High levels of agreement were
found between reviewers for all questions (plt.05).
Methods An assessment tool was designed by a
multi-disciplinary team. Staff (n 183) working
in the catchment areas of three hospitals were
trained in its use. Two months baseline data
were collected for non-conveyed fallers aged 65,
regarding adverse events within 14 days.
Following training, the assessment tool was
trialled for six months. Any case with an adverse
event was reviewed by clinicians in geriatric
medicine. An adverse event was described for
the purposes of the study as an unpredicted use
of the health service within two weeks of
original attendance. A serious adverse event
was defined as an unpredicted death or admission
to hospital within two weeks of the original
attendance.
Aim This study tested whether introduction of an
assessment tool would enable emergency ambulance
staff to leave older fallers at home safely.
Comment The study identifies that
non-conveyedolder people who have had a fall are
at high risk of re-attending services, although
the intervention was found to be associated with
a reduction in adverse events. While there was
agreement with the ambulance decision that
conveyance to the emergency department was not
required there was a high level of concern with
the lack of alternative rapid access to care for
these patients.
Contact Professor Helen Snooks, Centre for
Health Information, Research and Evaluation
(CHIRAL), School of Medicine, Swansea University,
Singleton Park, Swansea SA2 8PP Email
h.a.snooks_at_swansea.ac.uk
Results 1 Adverse events recorded during trial
period