How do Ambulance Service staff decide what to do for older adults who have fallen? An analysis of qualitative survey data.

Introduction:

Around 10% of calls received by English ambulance services are for older adults who have fallen¹; with an ageing population there are significant care provision needs. Decision-making on the treatment for people who fall, can impact their future physical and mental health. Previous research in decision-making of ambulance staff found perception of role, confidence, service demands and training to be key drivers². Previous work highlights drivers, but not experiences that explain why they occur.

Aim: to determine the experiences and confidence of frontline emergency clinicians in attending older adults who have fallen.

Method:

Online cross-sectional survey of frontline ambulance staff from one English ambulance service in May 2023. Including open questions that generated qualitative data for thematic analysis³. Ethical and regulatory approvals, and informed consent, were obtained.

Results:

81 participants completed the survey. Analysis identified three themes:

Care Pathways: Provision of hospital avoidance pathways varies throughout the region. Concerns arose from not knowing what different areas had and reduced accessibility out of hours.

“Only issue does arise when it’s between 1700 and 0900, as there’s very very limited alternative pathways” P6

Shared Decision-Making: Patients, family and clinicians were all valued as part of shared decision-making, with past feedback on decision-making informing future practice. 

Communication: Decision-making confidence was impacted by the participants experiences; positive experiences encouraged use of hospital avoidance pathways, whilst negative experiences impeded willingness to avoid hospital for fear of repercussion.

"Many services are helpful and willing to assist with education for hospital avoidance.” P18

Conclusion:

Prominent themes arose from the challenge of a regional and 24/7 ambulance service, not having consistent pathways available. This variation led to concerns when responding to patients outside of the clinician’s usual area and further challenges ambulance clinicians must balance in their practice.

References:

1. Snooks, Anthony, Chatters, et al. (2017) Health Technology Assessment, 21; 1-218.

2. Simpson, Thomas, Bendall, et al. (2017) BMC Health Services Research. 17; 299.

3. Braun and Clarke. (2006) Qualitative Research in Psychology, 3; 77-101.