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Foucaud A, Gilbert T, Vincent A, Jomard N, Comte B, Porthault S, Comte G, Theurey O, Gueugniaud PY, Bourelly L, Rabilloud M, Boutitie F, Douplat M, Tassa O, Haesebaert J, Termoz A, Schott AM. Evaluation of a training program for emergency medical service physician dispatchers to reduce emergency departments visits. J Am Geriatr Soc 2023; 71:484-495. [PMID: 36317929 DOI: 10.1111/jgs.18101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 09/08/2022] [Accepted: 09/24/2022] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Amandine Foucaud
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Gériatrie, Pierre Bénite, France
| | - Thomas Gilbert
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Gériatrie, Pierre Bénite, France.,Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Adélaïde Vincent
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Gériatrie, Lyon, France
| | - Nathalie Jomard
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Gériatrie, Pierre Bénite, France
| | - Brigitte Comte
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Gériatrie, Lyon, France
| | - Sylvie Porthault
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Hôpital Edouard Herriot, SAMU, Lyon, France
| | - Gaële Comte
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Hôpital Edouard Herriot, SAMU, Lyon, France
| | - Odile Theurey
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Hôpital Edouard Herriot, SAMU, Lyon, France
| | - Pierre-Yves Gueugniaud
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Hôpital Edouard Herriot, SAMU, Lyon, France
| | - Laura Bourelly
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Gériatrie, Lyon, France
| | - Muriel Rabilloud
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France.,Laboratoire de Biométrie et Biologie Évolutive, CNRS, UMR 5558, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Florent Boutitie
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France
| | - Marion Douplat
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service des Urgences, Pierre Bénite, France
| | - Ouazna Tassa
- Hospices Civils de Lyon, Pôle de Sante Publique, Service Recherche et Épidémiologie Cliniques, Lyon, France
| | - Julie Haesebaert
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France.,Hospices Civils de Lyon, Pôle de Sante Publique, Service Recherche et Épidémiologie Cliniques, Lyon, France
| | - Anne Termoz
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France.,Hospices Civils de Lyon, Pôle de Sante Publique, Service Recherche et Épidémiologie Cliniques, Lyon, France
| | - Anne-Marie Schott
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France.,Hospices Civils de Lyon, Pôle de Sante Publique, Service Recherche et Épidémiologie Cliniques, Lyon, France
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