Visits to home environments by emergency medical services: a statewide study

Psychiatric Consultations at an Emergency Department in a Metropolitan University Hospital in Northern Japan

Many patients with mental disorders visit emergency departments (EDs). However, the majority of these patients do not receive psychiatric assessment. In the present study, we investigated the detailed proportion of patients with mental disorders visiting an urban ED in the largest northern city in Japan. A retrospective chart review study was performed at a University Hospital from January 2012 to December 2015. The reasons for psychiatric consultations made by ED staff, and the primary psychiatric diagnoses were investigated. Among all living patients, 20% of them received consultations. The most common reason for consultation was suicide attempt followed by agitation or insomnia. Of all diagnoses, organic mental disorder was the most frequent and the mean age was significantly higher than the other diagnostic groups. Our study indicated that the frequency of psychiatric consultation was high. This indicates the high demand for mental health services at the ED. A thorough psychiatric assessment can provide adequate psychiatric services to acute patients; thereby possibly preventing suicide attempters from later actually dying by suicide.

Development of a community health and wellness pilot in a subsidised seniors' apartment building in Hamilton, Ontario: Community Health Awareness Program delivered by Emergency Medical Services (CHAP-EMS)

BACKGROUND

Older adults have higher risk of developing cardiovascular disease, diabetes and falls, leading to costly emergency medical service (EMS) calls and emergency room visits. We developed the Community Health Assessment Program through EMS (CHAP-EMS) that focuses on health promotion/prevention of hypertension and diabetes, links with primary care practitioners, targets seniors living in subsidized housing, and aims to reduce morbidity from these conditions, thereby reducing EMS calls. In this pilot study, we evaluated the feasibility of implementing the CHAP-EMS, attendance rates, prevalence of high blood pressure and cardiovascular risk factors.

METHODS

In this pilot study the CHAP-EMS was implemented in the intervention site over a 12 month period. BP, lifestyle, cardiovascular risk and EMS call rates were collected and descriptive analyses performed. Participants were residents (low income seniors) of a subsidized housing complex in Hamilton, Ontario. Two paramedics provided once-weekly sessions, measuring BP, assessing diabetes/lifestyle risk (CANRISK questionnaire) and discussed prevention/local wellness activities in the intervention site. Follow up was invited.

RESULTS

A total of 1365 visits with 79 unique participants occurred; 48 (25.2%) visited at least twice; mean age was 72.2; 87.2% were 65 years of age and older and 68.1% were female; 90.3% had a family doctor. Overall, 45.2% had elevated BP initially from the total; 50.0% of participants previously diagnosed with hypertension had elevated BP while 33.3% not previously diagnosed had elevated BP. Almost 1 in 5 (19.4%) had diabetes; 66.7% had moderate to high risk of developing diabetes.

CONCLUSION

This pilot study indicates that CHAP-EMS is a feasible program that could have impact on BP, lifestyle factors, diabetes risk and EMS calls in the buildings in which it was implemented.

Emergency medical services screening of elderly falls in the home

OBJECTIVES

Previous studies of injury prevention among the elderly have focused on care by community-based services for the elderly. The plan for this study was to determine whether emergency medical services (EMS) could be a valuable partner in an injury prevention program for the elderly. The purposes of the study were: 1) to determine whether it is feasible to gather injury prevention data prospectively, 2) to determine whether these data suggest the need for further intervention to aid the elderly, and 3) to determine whether retrospective chart data are comparable to prospectively gathered data for evaluating the elderly home environment.

METHODS

Trained fire/EMS chiefs gathered prospective data from the homes of all elderly falls. Patients were included if they were 65 years of age or older. Demographics extracted from the chart were gender, age, and average income based on zip code information from the city office. A 29-question survey was developed based on a literature review. Results were obtained representing information in six categories: environment, appearance, health, violence, access to help, and repeat medical care utilization. Retrospective data were obtained from run reports and from a computerized EMS database. Proportions and 95% confidence intervals were used. A p-value < 0.05 was considered statistically significant.

RESULTS

There were 70 prospective elderly fall cases evaluated and 74 retrospective charts reviewed, each representing a two-to-four-month period. Prospectively, significant problems were found with the patient's environment in up to 53% of cases, appearance in up to 29%, health in up to 77%, abuse in up to 3%, access in up to 57%, and repeat use in 33-68%. Although there were no differences in the age, income, or percentage transported between the prospective and retrospectively obtained groups, a significantly higher percentage of females were entered prospectively. Retrospective chart review obtained reasonable amounts of data for only four of 29 questions.

CONCLUSION

Prospective analysis is easily gathered and identifies elderly injuries and patterns. A significant number of elderly patients whose homes were visited by EMS need help. Retrospective analysis gleans little injury prevention information.

Repeat EMS transports among elderly emergency department patients

OBJECTIVES

Previous studies of repeat care of the elderly have focused on trauma cases only. The purposes of this study were to identify repeat transports of elderly patients to the authors' emergency department (ED) by emergency medical services (EMS), to identify demographics, and to compare chief complaints.

METHODS

A population-based, retrospective cohort study was conducted. Data for this study were obtained from computerized registration files in an urban, university-affiliated ED with an annual census of approximately 60,000 visits. Patients were included if they were 65 years of age or older and they were transported by EMS in 1997. The repeater group included patients who had one or more EMS transports within the following 12 months. The comparison group was composed of all patients with no further EMS transport within the 12 months after the index visit. Demographics extracted from the database were gender, chief complaint, total number of visits, and time since previous visits. Repeats were characterized by frequency (number of visits in 12 months after the index visit), type (visit for same vs different complaint), and rate (time to the first return visit). Repeaters were defined as more than one visit within a 12-month period. Repeaters were subdivided as follows: "immediate" (within 72 hours), "short-term" (within 2 months), and "long-term" (within 12 months). Chi-square and 95% confidence intervals (95% CIs) were used. A p-value < 0.05 was considered statistically significant.

RESULTS

There were 365 (23%) repeaters and 1,212 (77%) nonrepeaters. Repeaters accounted for 811 (40%) of the total of 2,023 elderly patients transported by EMS. Fifty-seven percent of all elderly patients transported by EMS were female, with no significant difference between the repeaters and nonrepeaters. There were significantly fewer transports for a chief complaint of trauma among the repeaters than among the nonrepeaters (14% vs 26%, diff = 12, 95% CI = 9-15%). Among the 365 repeaters, 186 (51%) had two transports, 92 (15%) had three transports, 36 (10%) had four transports, and 51 (14%) had five or more transports. Of the return transports by repeaters, 40 (12%) were "immediate," 191 (52%) were "short-term," and 134 (36%) were "long-term."

CONCLUSION

Repeaters accounted for 18% of elderly ED patients transported by EMS and 40% of elderly transports to the authors' ED. There were significantly fewer trauma transports in the repeater group. One-half of the repeaters returned only once in a 12-month period and a third of these occurred more than three months apart. It is important to understand the characteristics of elderly EMS repeaters in order to use this opportunity for intervention.