• Ambulance attendance at diabetes or diabetes-related emergencies in care homes – cross sectional database study

      Siriwardena, Aloysius; Law, Graham; Smith, Murray D.; Iqbal, Mohammad; Phung, Viet-Hai; Spaight, Anne; Brewster, Amanda; Mountain, Pauline; Spurr, Keith; Ray, Mo; et al. (2019-09-24)
      Background Diabetes, which affects over 1 in 5 nursing or care home residents, may lead to diabetes-related emergencies with ambulance call-outs and hospitalisation. Our aim was to investigate the epidemiology of diabetes-related emergencies in care home residents which involved an ambulance attendance. Methods We used a cross-sectional design to investigate emergency ambulance attendances to people in nursing and residential care homes presenting with diabetes-related emergencies across the East Midlands between January 2012 and December 2017. We used clinical and dispatch data from East Midlands Ambulance Service NHS Trust (EMAS) and care home data from the Care Quality Commission, including call category, timing, location, place of residence, clinical or physiological status, treatments, outcome (conveyance) and costs in the analysis. Results Overall 219722 (6.7% of 3.3 million) attendances were to care home residents of which 12080 were for diabetes-related emergencies. Of 3152 care home patients categorised as having a ‘diabetic problem’ 1,957 (62.1%) were conveyed to hospital. This was not significantly different to the rate for other patients, taking into account other factors, despite access to trained staff in care homes. Statistically significant factors associated with conveyance included reduced consciousness level (OR 0.91, 95% CI 0.87–0.95), elevated heart (1.01, 1.01–1.02) or respiratory rate (1.08, 1.06–1.10), no treatment for hypoglycaemia (0.54, 0.34–0.86) or additional co-morbid medical (but not psychiatric) problems. Cost to EMAS was significantly lower when a patient was conveyed, by some £18 (95% CI £11.94–£24.12), but this would not outweigh downstream NHS costs arising from hospital care. For the simulation in which all trusts mean NHS Reference Costs were used, conveyance was no longer significant in the cost model. Conclusion Conveyance to hospital was common for care home patients with diabetes-related emergencies and more likely when conscious level was impaired, certain physiological measures abnormal or treatment for hypoglycaemia was not given. https://emj.bmj.com/content/36/10/e8.3 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/emermed-2019-999abs.18
    • Ambulances attending diabetes-related emergencies in care homes – cross sectional database study

      Siriwardena, Aloysius; Law, Graham; Smith, M.D.; Iqbal, Mohammad; Phung, Viet-Hai; Spaight, Anne; Brewster, Amanda; Mountain, P.; Spurr, K.; Ray, M.; et al. (2019-04-26)
      Background Diabetes, affecting 1 in 5 care home residents, may lead to ambulance call-outs and hospitalisation. We aimed to investigate the epidemiology of diabetes-related emergencies involving ambulance attendances to care home residents. Method Cross-sectional design investigating ambulance attendance to people presenting with diabetes-related emergencies in the East Midlands, UK, between 2012 and 2017. We analysed dispatch and ambulance clinical data with care home data, including call category, timing, location, care home type, clinical or physiological measures, treatments, conveyance (transport to hospital) and costs. Results Overall 2 19 722 (6.7% of 3.3 million) ambulances attended care homes over 6 years, with 12 080 (5.5%) to diabetes-related emergencies. Of 3152 care home patients categorised as having a ‘diabetic problem’, 1957 (62.1%) were conveyed to hospital, similar to that for community residents taking into account other factors. Factors associated with conveyance included reduced consciousness (OR 0.91, 95% CI 0.87–0.95), elevated heart (1.01, 1.01–1.02) or respiratory rate (1.08, 1.06–1.10), no treatment for hypoglycaemia (0.54, 0.34–0.86) or additional medical (but not psychiatric) problems. Ambulance costs were significantly lower when a patient was conveyed, by some £18 (95% CI £11.94–£24.12), but this would be outweighed by downstream hospital care costs. For a simulation in which all trusts’ mean NHS Reference Costs were used, conveyance was no longer significant in the cost model. Conclusion Conveyance following diabetes-related emergencies was as common for care home as for other community residents despite access to trained staff, and more likely with impaired consciousness, abnormal physiological measures or lack of treatment for hypoglycaemia. Conflict of interest None. Funding National institute for Health Research Collaboration for Leadership in Applied Health Research and Care East Midlands, UK., https://bmjopen.bmj.com/content/9/Suppl_2/A11.2. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/bmjopen-2019-EMS.30
    • Community falls prevention for people who call an emergency ambulance after a fall: an economic evaluation alongside a randomised controlled trial

      Sach, Tracey H.; Logan, Phillipa; Coupland, Carol A.C.; Gladman, John R.F.; Sahota, Opinder; Stoner-Hobbs, Valarie; Robertson, Kate; Tomlinson, Vicki; Ward, Marie; Avery, Anthony J. (2012-09)