Abstract
Introduction
Frail adults should be offered comprehensive geriatric assessment. Falls are the most common reason for conveyance to hospital for Nursing Home (NH) residents in SBUHB and are associated with mortality, morbidity and are a significant burden on Welsh Ambulance Service (WAST) and the Emergency Department (ED). Older people are often subject to long ambulance waits and offload delays. By using a collaborative approach, we aim to reduce hospital conveyance rates and adverse patient outcomes.
Methods
Phase 1 - WAST calls analysed January 2020 – February 2022 from Swansea Bay UHB NH concerning Falls/ Potential Falls where an Emergency vehicle attended the scene. Education provided about post-fall management in Swansea NH’s in March 2022. Phase 2- Development of a referral pathway with Acute-GP unit (AGPU) and Advanced Practice Paramedic (APP) colleagues who review the WAST “live stack” allowing calls to be diverted to Older Person’s Assessment Service (OPAS). OPAS also offer same-day assessment for NH residents (and others) directly.
Results
March-July 2022, 980 calls from SBUHB NH, 195 falls (19.9%), additional 228 potential falls (22.67%). There was significant change in conveyance (p <0.05) with no change in call nature or call frequency (p >0.05). Per month, the mean conveyance reduction was 20 patients. In addition, OPAS review 8 (mean) patients from NH directly each month, bypassing WAST.
Conclusions
Falls remain a significant burden on ED and WAST and we have shown education plus collaboration between AGPU, WAST and OPAS shows significant conveyance reduction, ultimately delivering a better patient experience and system efficiency. Each call-out has a cost per hour of £101.34, with average offload for those >65 years old being 406 minutes, saving a minimum of £25000 a month. Future directions include expanding post-fall education to NH in Neath/Post Talbot and WAST first responders and piloting a rapid-response vehicle