Here is the standardised PICO analysis for the fiftieth uploaded article:
Full Title
Residential aged care homes: Why do they call ‘000’? A study of the emergency prehospital care of older people living in residential aged care homes
Authors: Rosamond A. Dwyer, Belinda J. Gabbe, Thach Tran, Karen Smith, Judy A. Lowthian
Journal: Emergency Medicine Australasia, 2021; 33:447–456
Type of Study
Retrospective cohort study using linked administrative data from Ambulance Victoria and population datasets (2008–2013)
PICO Summary
Population (P)
- Older adults (aged ≥65 years) residing in residential aged care (RAC) homes in Victoria, Australia
- N = 188,849 emergency ambulance attendances over 5 years
- Mean age = 85 years; 63% women; >30% had dementia; high Charlson comorbidity scores (≥5 in 74%)
Intervention (I)
- Description and analysis of prehospital emergency care provided by Ambulance Victoria to RAC residents:
- Reason for call
- Clinical assessment
- Vital signs and acuity
- Medical interventions and medication administration
- Transport outcomes
Comparison (C)
- No formal comparator group; descriptive analysis includes stratification by gender and clinical indication (e.g., fall vs. medical condition)
Outcomes (O)
System-level outcomes:
- 90% of residents were transported to hospital following ambulance attendance
- 58% of calls occurred outside regular business hours
- Only 50% received any prehospital intervention other than reassurance
- Less than 25% received IV fluids or medication
Clinical characteristics:
- Polypharmacy common: mean of 7.9 medications per resident
- 74% on antibiotics
- 25% on opioids
- 24% on sedatives
- 15% on antipsychotics
- High prevalence of dementia (33%) and complex comorbidities (mean 5.4 diagnoses)
Common reasons for call-out:
- Falls (15%)
- Pain
- Respiratory tract infection
- Altered mental state
- Non-specific febrile illness
Gender differences:
- Women more frequently experienced falls and pain
- Men more likely to present with respiratory complaints
Findings Summary
This is the first large-scale study in Australia to characterise emergency ambulance use and prehospital care for RAC residents. Key insights:
- High clinical complexity and frailty in residents
- Frequent transport to hospital despite relatively low acuity presentations
- Low intervention rates by paramedics, suggesting potential overuse of ambulance services for issues that may be managed in alternative care pathways
- Calls clustered during mornings and evenings, often outside business hours
The authors advocate for:
- Alternative acute care pathways such as Hospital-in-the-Home, mobile outreach teams, and enhanced telehealth support
- Staff education and training in RAC homes
- Greater access to GP and community-based support services
These findings support rethinking emergency response protocols for RAC populations to better match service intensity to clinical need and reduce unnecessary hospitalisation.
Life In The Slower Lane 
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