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Predictors and outcomes of ambulance calls to diabetic emergencies in care homes

Predictors and outcomes of ambulance calls to diabetic emergencies in care homes – retrospective observational database study

What we are doing:

We are using routinely collected information from East Midlands Ambulance Service over a six-year period – January 2012 to December 2017 from over 3 million patients, to study care home residents with diabetes who are attended by an ambulance. We are investigating ambulance calls to care homes to understand which patients are being taken to hospital and whether this is something to do with the patient, the care or the severity of their condition. We are also calculate the costs of care depending on whether a care home resident with diabetes is left at the home or taken to hospital.

Why we are doing it:

Diabetes is common in care homes, nursing or residential, with over one in five residents affected. Healthcare for residents with diabetes is sometimes not as good as it could be leading to diabetes getting worse, giving rise to emergency conditions due to very low or high blood sugar or related problems. This can often result in an ambulance being called by care staff and the patient needing to be taken to hospital or admitted; a course of action which could be prevented by better initial care or alternative courses of action.

What the benefits will be:

The benefits to the NHS locally and nationally will be to: 

  • Inform development of educational interventions and pathways for ambulance and care home staff to reduce preventable call-outs and hospital admissions for diabetes emergencies.
  • Increase knowledge of organisational, patient and clinical factors leading to hospital admission following diabetes-related emergencies in care home residents.
  • Publish new evidence on the scale, nature and costs of diabetes emergencies in care homes.
  • In future, reduce risk of hypoglycaemia, hyperglycaemia and dehydration in people with diabetes in care homes.

Who we are working with:

We are working with a team including clinical academics (Professor Niro Siriwardena and Professor Kamlesh Khunti), experts from ambulance services (Anne Spaight), primary, secondary (Dr Iskandar Idris) and social care (Prof Mo Ray), together with a statistician (Professor Graham Law), health economist (Dr Murray Smith). 

Other researchers (Dr Mohammad Iqbal, Viet-Hai Phung) have supported the project. We are also working with patients and the public through Amanda Brewster, chair and Pauline Mountain, member, of the Healthier Ageing Patient and Public Involvement (HAPPI) group at the University of Lincoln, and Keith Spurr, chair of the South Lincolnshire Diabetes Forum.

Study Lead:

Name: Professor Niroshan Siriwardena

Role: Professor of Primary and Prehospital Health Care/Associate Clinical Director

Organisation: University of Lincoln/East Midlands Ambulance Service NHS Trust

Contact:

Professor Niroshan Siriwardena, nsiriwardena@lincoln.ac.uk