Referral pathway of patients aged 75 years and older after a telephone triage by the French emergency medical communication center (SAMU)

Evaluation of a training program for emergency medical service physician dispatchers to reduce emergency departments visits

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.