This article is more than 5 years old. Information may no longer be current.
Paramedic, PCP collaboration reduces unnecessary transport to ED for fallen elderly
Click Here to Manage Email Alerts
Consultation between emergency medical services and primary care physicians safely triaged elderly residents in assistant living with simple falls, significantly decreasing unnecessary transport to the ED, according to findings published in Annals of Internal Medicine.
“Frequent simple falls happen often in elderly people, with wide variability — whether the patient is ill/hurt or not,” Jefferson G. Williams, MD, MPH, from Wake County Emergency Medical Services, Raleigh, and University of North Carolina at Chapel Hill, told Healio Internal Medicine. “The medical community and assisted living facility leadership need to figure out how to appropriately evaluate and care for them without having to send them to the ED, possibly unnecessarily, every single time.”
Williams and colleagues performed a prospective cohort study of 22 assisted living facilities with 953 residents (mean age, 86 years; 76% female) to determine if unnecessary transport to the ED can be avoided in elderly patients using a protocol developed to minimize transport. The protocol included collaboration via telephone among paramedics dispatched to provide emergency medical services to residents who had ground-level falls and the patients’ primary care providers.
Data indicated that there were 840 falls among 359 residents in 43 months. Transport to the ED was not recommended by the protocol for 553 of the falls. A time-sensitive condition was observed in 11 patients who had a nontransport recommendation. According to the researchers, appropriate care was given to at least seven of these patients with four being transported to the ED despite the protocol recommendation and three being successfully treated for minor injuries on site.
Of the patients transported despite protocol recommendations, three underwent outpatient radiography which uncovered fractures from the falls. The last patient experienced vomiting and diarrhea and initiated palliative care, then died 60 hours after the fall.
Appropriate care was given to a majority of patients (99.3%; 95% CI, 98.2-99.8) who had a protocol recommendation for nontransport.
“The key components of implementing these findings are an EMS system willing to consider a nontransport protocol and train their paramedics on its use, and a primary care group willing to take phone calls from paramedics to help come up with a plan of care, and to see its patients on a ‘next day’ basis,” Williams said.
The next step is to analyze the cost-effectiveness of this and similar programs, he said, adding that there could be a real potential for health care cost savings.
“EMS colleagues can participate in the care of primary care patients and the relationship between EMS and PCPs can really be a win-win-win for patients, paramedics and physicians,” Williams said. “Getting the ‘right resource to the right patient at the right place at the right time’ is something that we as physicians should achieve for our patients, and EMS can really help with that. Paramedics are health care providers, not just a transport resource.” – by Alaina Tedesco
Disclosure: Williams reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.