Will Jones (Business Analyst) and Jay Banerjee (Consultant in Geriatric Emergency Medicine)
We have been testing out a prehospital scheme in the UK’s Leicester, Leicestershire and Rutland area since the beginning of COVID.
It was originally conceived to support residence-based care for frail older people, some of whom may not benefit from hospital conveyance and be exposed to the risks of COVID.
The scheme includes senior clinicians with frailty competencies providing telephone support to ambulance crews. The aim is to develop a definitive management plan for care in the community or if the individual’s needs outstripped timely care provision, a conveyance to the hospital’s emergency department.
A prehospital decision support emerged from the scheme which will be further evaluated. This considers an early warning score, the frailty state, advance care plans and weaves them into a conversation around best interest including ethical and legal considerations for the many incapacitated individuals.
Data around impact is being analyzed but emerging information suggests 380 admissions were avoided for every 587 “do not convey” advice, from 1075 calls received by a single clinician over 180 days in a 15 month period. The table below compares the cohort by CFS and expected admission rate is from the rest of the ED ambulance attendances in the over 65’s. The department sees over 40,000 older people (>65 years) conveyed by ambulance per 12-month period so this 1075 would have made a very small impact on attendance volumes but would have freed up significant bed space for the hospital over 1 year with an average 10-day length of stay. Such schemes can yield high benefits for stressed systems.