Background
Emergency Departments (ED) have seen an increasing number of older patients who are mostly referred following a call to the Emergency Medical Services (EMS). Long waiting times in settings, which are not designed to meet older patients' needs, may increase the risk of hospital‐acquired complications. Unnecessary visits should therefore be avoided as much as possible. The objective of the study was to evaluate whether a program to provide geriatric knowledge and tools to the dispatching physicians of the EMS could decrease ED referrals of older patients.
Methods
Design: Before‐and‐after study with two 6‐month periods before and after intervention.
Participants: All calls received by a dispatching physician of the Rhône EMS from 8 am to 6 pm concerning patients aged 75 years or above during the study period.
Intervention: A program consisting of training dispatching physicians in the specific care of older patients and the developing, with a multidisciplinary team, of specific tools for dispatching physicians.
Outcome: Proportion of ED referrals of patients aged 75 years or above after a call to the EMS.
Results
A total of 2671 calls to the Rhône EMS were included corresponding to 1307 and 1364 patients in the pre‐and post‐intervention phases, respectively. There was no significant difference in the proportion of referrals to the ED between the pre‐intervention (61.7%) and the post‐intervention (62.8%) phases (p = 0.57). Contact of the patients with their General Practitioner (GP) in the month preceding the call was associated with a 22% reduced probability of being referred to an ED.
Conclusions
No beneficial effect of the intervention was demonstrated. This strategy of intervention is probably not effective enough in such time‐constraint environment. Other strategies with a specific parallel dispatching of geriatric calls by geriatricians should be tested to avoid these unnecessary ED referrals.
Trial registration: ClinicalTrials NCT02712450.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.