Overnight Ambulance Referrals to Urgent Community Response and Frailty Services to Avoid Unnecessary Hospital Conveyance

Introduction

Overnight, frail older adults are often conveyed to the Emergency Department (ED) despite being clinically stable, due to a lack of reliable follow-up. Overnight stays in ED can contribute to avoidable hospital admissions, risk of deconditioning, delirium, and ED crowding.

Through collaborative working with West Midlands Ambulance Service (WMAS), a “safe to stay at home” pathway was developed linking next-day frailty review via the Urgent Community Response team (UCR).

Methods

Patients assessed by WMAS between 20:00 and 08:00 and deemed safe to remain at home were referred for Urgent Community Response (UCR) review the following morning via Consultant Connect.

Referral data from January-March 2026 were retrospectively analysed using Consultant Connect and electronic patient records. Data collected included referral reason, intervention(s), clinician grade, and caseload duration. Outcome measures included subsequent ED attendances within 24-78 hours of referral. Subjective outcomes of feedback from WMAS regarding acceptability and user/staff experience were also collected.

Results

A total of 100 referrals were received. The commonest referral reasons were fall (57)), respiratory symptoms (10) and confusion (7). Out of the 100 patients, 42 were seen by Advanced Clinical Practitioner/Clinical Practitioner with the remaining seen by UCR nurses or therapists. The

majority of patients were from care homes (39). 12 patients remained on the frailty virtual ward caseload, with only 4 patients subsequently referred to hospital.

WMAS reported confidence in the robust follow-up pathway and felt empowered to safely support frail older adults to remain at home.

Conclusion and Impact

This innovative and collaborative pathway provides paramedics with a reliable alternative to hospital conveyance for frail patients who are safe to remain at home and may benefit from further clinical review. This supports frail older adults’ independence, and preserves comfort and dignity. As a result, emergency department pressures are reduced through community-based assessment and management.