• Hospital admission avoidance for people with exacerbations of chronic obstructive pulmonary disease (COPD) through collaborative working between Suffolk COPD services and East of England Ambulance service

      Pearce, L.J.; Broad, M.; Pulimood, T.B.; Laroche, C.M. (2011-12)
      Introduction BTS Guidelines recommend that admission avoidance schemes should be available for patients with exacerbations of COPD. The Suffolk COPD Service was established in 2009, operating 365 days/year. One strand of the service aims to avoid inappropriate hospital admission by encouraging GPs to refer to the service rather than sending patients into hospital. However, despite wide publicity hospital admission rates remained high. Review of 24 COPD hospital admissions suggested that 50% would have been suitable for admission avoidance through Suffolk COPD Services. 95% of these patients had been brought in to A&E by ambulance. Feasibility of direct ambulance referral into Suffolk COPD Services was discussed with ambulance personnel. Method A business case, working protocol and pathway were developed jointly, along with a robust clinical governance system. It was planned that a member of the Suffolk COPD Nursing team would visit the patient within 4 h of referral. Approval was gained from the Local Medical Council and Expert Clinical Steering Group. The system was launched following wide publicity and training of both ambulance and nursing staff. Results The first successful referral was received 40 min after the launch. In the first year 83 referrals were received, of which only eight were inappropriate and requiring redirection to other services or hospital admission. Advantages of ambulance referral system: < Reduction in ambulance call cycle time by up to 30 min < Increased ambulance personnel COPD knowledge < Development of patient group directives < Improved team working/collaboration across services < Ability to discharge duty of care to a specialist community service < Increased admission avoidance < People cared for in own home < “Self supported” care encouraged < Cost efficient Conclusion 73% were admissions avoided compared to the 50% which had been predicted. The collaboration was a successful model of service delivery, reducing hospital admissions by the seamless transition of the duty of care from the ambulance service to the Suffolk COPD Services, who supported the patient at home. https://thorax.bmj.com/content/thoraxjnl/66/Suppl_4/A105.2.full.pdf 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/ http://dx.doi.org/10.1136/thoraxjnl-2011-201054c.93
    • How do people with dementia use the ambulance service? A retrospective study in England: the HOMEWARD project

      Voss, Sarah; Brandling, Janet; Taylor, Hazel; Black, Sarah; Buswell, Marina; Cheston, Richard; Cullum, Sarah; Foster, Theresa; Kirby, Kim; Prothero, Larissa; et al. (2018-08)
      https://bmjopen.bmj.com/content/8/7/e022549 Objectives An increasing number of older people are calling ambulances and presenting to accident and emergency departments. The presence of comorbidities and dementia can make managing these patients more challenging and hospital admission more likely, resulting in poorer outcomes for patients. However, we do not know how many of these patients are conveyed to hospital by ambulance. This study aims to determine: how often ambulances are called to older people; how often comorbidities including dementia are recorded; the reason for the call; provisional diagnosis; the amount of time ambulance clinicians spend on scene; the frequency with which these patients are transported to hospital. Methods We conducted a retrospective cross-sectional study of ambulance patient care records (PCRs) from calls to patients aged 65 years and over. Data were collected from two ambulance services in England during 24 or 48 hours periods in January 2017 and July 2017. The records were examined by two researchers using a standard template and the data were extracted from 3037 PCRs using a coding structure. Results Results were reported as percentages and means with 95% CIs. Dementia was recorded in 421 (13.9%) of PCRs. Patients with dementia were significantly less likely to be conveyed to hospital following an emergency call than those without dementia. The call cycle times were similar for patients regardless of whether or not they had dementia. Calls to people with dementia were more likely to be due to injury following a fall. In the overall sample, one or more comorbidities were reported on the PCR in over 80% of cases. Conclusion Rates of hospital conveyance for older people may be related to comorbidities, frailty and complex needs, rather than dementia. Further research is needed to understand the way in which ambulance clinicians make conveyance decisions at scene. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6074617/pdf/bmjopen-2018-022549.pdf 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/ http://dx.doi.org/10.1136/bmjopen-2018-022549
    • A qualitative study on conveyance decision-making during emergency call outs to people with dementia: the HOMEWARD project

      Voss, Sarah; Brandling, Janet; Pollard, Katherine; Taylor, Hazel; Black, Sarah; Buswell, Marina; Cheston, Richard; Cullum, Sarah; Foster, Theresa; Kirby, Kim; et al. (2020-01-29)