The work package will identify all Yorkshire Ambulance Service (YAS) ambulance calls for patients unable to get up following a fall for a period of 24 months. Data from a linked dataset (CUREd+) will be used to describe the characteristics of ambulance service patients who have been unable to get up after a fall. This will use data from 999 ambulance calls, NHS 111, Emergency Departments, Hospital admissions and basic mental health services data from 2017-2023. 

This data will be used to understand the incidence of long leis after a fall, including when and where they happen and the estimated length of time waiting for an ambulance. This will then be used to quantify patient care trajectory and resource use, to understand any differences between patients who have had a long lie and those whose fall did not result in a long lie. 

For the 12 months following an ambulance call, urgent and emergency care access and Healthcare Resource Group (HRG) reference costs will be used to understand the costs of ambulance service journeys, emergency department attendances, non-elective inpatient admissions and subsequent hospital stays as well as outpatient care. 

Analysis will explore the length of lie on cost outcomes for both healthcare related costs and costs related to urgent and emergency care (ED attendances, acute admissions, ambulance calls, NHS 111, and outpatient costs), adjusting for length of lie as well as other variables such as age, sex, deprivation, ethnicity and clinical characteristics such as comorbidities and time of the fall. 

This work package will provide a more nuanced and detailed understanding of a patient’s care trajectory after they have called 999 after a fall. A detailed notes review will be taken to explore post-fall management and treatment pathways of 200 patients who have a long lie within the Yorkshire and Humber region and are transported to one of 4 participating hospitals. 

Data will be analysed for 90 days following a fall, involving the patient’s full health and social care record to understand the patient’s care from ambulance, emergency department, hospital, and community health and social care records. This is exploratory and will be used to understand the mechanisms by which a long lie impacts upon a patient's care trajectory, including whether patients have been advised to avoid food and drink, patient frailty and any variables that are not available in routine health data important to long lies. 

WP4a- Ambulance service interventions for managing long lies 

WP4b- Care home management initiatives to mitigate long lies while waiting for ambulances 

WP4c- national online survey for wider participation on long lies interventions from residential, nursing homes and other social care providers. 

From these surveys, descriptive analysis of interventions from ambulance services and care providers will be created to understand context to existing long lies interventions.  

Interviews will be carried out across 3 ambulance service areas to understand the perspectives of key stakeholders managing long lies in community, pre-hospital and hospital care. This work package will aim to understand the impact of long lies on participant’s work perceptions, work loads, experiences and patient care trajectories. This will include how the management of long lies impacts staff and strategies to avoid harm whilst waiting for ambulance attendance, hospital admission or during the patient’s hospital stay. 

Patients who have fallen and had a long lie, and/or their carers will be interviewed in two short interviews. The first interview will take place shortly after the fall and the second within 3-6 months, enabling the researchers to collect information about the immediate impact of a fall and the impact it has had on their lives in the 3-6 months following. These interviews will be developed to explore the impact of advice the patient received, their experiences of the long lie and ambulance wait as well as personal impacts of the fall on their dignity, confidence and social factors. These interview guides will be developed with support from the PPI group to recognise the sensitivity of the topic which may be emotionally demanding for both patients and their carers.  

Each work package focuses on different aspects and perspectives of the research question: What is the scale, impact and care trajectory for patients who have a long lie after a fall and what interventions might mitigate the impact of a long lie? The findings will then be triangulated to integrate all data sources and improve learning.  

Workshops with stakeholders will take place to co-develop guidance for managing long lies that address key stages of the patient’s journey. Workshops will take place with stakeholders who are: 1) People at risk of falling or their carers (including care home staff); 2) Ambulance service (both clinicians and call handling staff) to understand the advice given to people who have fallen and how to hand over care of conveyed patients; 3) hospital staff to understand how to manage people conveyed after a long lie, tests needed for long lie management and patients who have to be admitted. 

These workshops will present findings of the study to gather stakeholder views on interventions that could reduce the detrimental consequences of long lies after a fall for patients and healthcare systems. The workshops will use process mapping to understand the reality of each group’s perspective, including identifying barriers and problems for implementation. 

A final workshop will draw together findings to present each perspective and ensure there is a shared understanding on guidance, this workshop will produce guidance and recommendations across different organisation types and will give practical and easily implementable ways to reduce the risk of long lies.