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Batt AM, Lysko M, Bolster JL, Poirier P, Cassista D, Austin M, Cameron C, Donnelly EA, Donelon B, Dunn N, Johnston W, Lanos C, Lunn TM, Mason P, Teed S, Vacon C, Tavares W. Identifying Features of a System of Practice to Inform a Contemporary Competency Framework for Paramedics in Canada. Healthcare (Basel) 2024; 12:946. [PMID: 38727503 PMCID: PMC11083595 DOI: 10.3390/healthcare12090946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/28/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024] Open
Abstract
INTRODUCTION Paramedic practice is highly variable, occurs in diverse contexts, and involves the assessment and management of a range of presentations of varying acuity across the lifespan. As a result, attempts to define paramedic practice have been challenging and incomplete. This has led to inaccurate or under-representations of practice that can ultimately affect education, assessment, and the delivery of care. In this study, we outline our efforts to better identify, explore, and represent professional practice when developing a national competency framework for paramedics in Canada. METHODS We used a systems-thinking approach to identify the settings, contexts, features, and influences on paramedic practice in Canada. This approach makes use of the role and influence of system features at the microsystem, mesosystem, exosystem, macrosystem, supra-macrosystem, and chronosystem levels in ways that can provide new insights. We used methods such as rich pictures, diagramming, and systems mapping to explore relationships between these contexts and features. FINDINGS When we examine the system of practice in paramedicine, multiple layers become evident and within them we start to see details of features that ought to be considered in any future competency development work. Our exploration of the system highlights that paramedic practice considers the person receiving care, caregivers, and paramedics. It involves collaboration within co-located and dispersed teams that are composed of other health and social care professionals, public safety personnel, and others. Practice is enacted across varying geographical, cultural, social, and technical contexts and is subject to multiple levels of policy, regulatory, and legislative influence. CONCLUSION Using a systems-thinking approach, we developed a detailed systems map of paramedic practice in Canada. This map can be used to inform the initial stages of a more representative, comprehensive, and contemporary national competency framework for paramedics in Canada.
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Affiliation(s)
- Alan M. Batt
- Faculty of Health Sciences, Queen’s University, 99 University Avenue, Kingston, ON K7L 3N6, Canada
- Department of Paramedicine, Monash University, Building H, Peninsula Campus, 47–49 Moorooduc Hwy, Frankston, VIC 3199, Australia; (J.L.B.); or (C.C.); (C.L.); (T.M.L.)
| | - Meghan Lysko
- Oxford County Paramedic Services, 377 Mill Street, Woodstock, ON N4S 7V6, Canada;
| | - Jennifer L. Bolster
- Department of Paramedicine, Monash University, Building H, Peninsula Campus, 47–49 Moorooduc Hwy, Frankston, VIC 3199, Australia; (J.L.B.); or (C.C.); (C.L.); (T.M.L.)
- BC Emergency Health Services, Clinical Governance and Professional Practice, 2955 Virtual Way, Vancouver, BC V5M 4X3, Canada
| | - Pierre Poirier
- Paramedic Association of Canada, 201-4 Florence Street., Ottawa, ON K2P 0W7, Canada; (P.P.); (D.C.)
- Ottawa Paramedic Service, 2465 Don Reid Drive, Ottawa, ON K1H 1E2, Canada; (W.J.)
| | - Derek Cassista
- Paramedic Association of Canada, 201-4 Florence Street., Ottawa, ON K2P 0W7, Canada; (P.P.); (D.C.)
| | - Michael Austin
- Department of Emergency Medicine, The Ottawa Hospital, University of Ottawa, 2475 Don Reid Drive, Ottawa, ON K1H 1E2, Canada;
| | - Cheryl Cameron
- Department of Paramedicine, Monash University, Building H, Peninsula Campus, 47–49 Moorooduc Hwy, Frankston, VIC 3199, Australia; (J.L.B.); or (C.C.); (C.L.); (T.M.L.)
- Canadian Virtual Hospice, One Morley Avenue, Winnipeg, MB R3L 2P4, Canada
| | - Elizabeth A. Donnelly
- School of Social Work, University of Windsor, 167 Ferry Street, Windsor, Ontario, ON N9A 0C5, Canada;
| | - Becky Donelon
- Health Sciences Division, Justice Institute of British Columbia, 715 McBride Boulevard, New Westminster, BC V3L 5T4, Canada;
| | - Noël Dunn
- Saskatchewan Health Authority, 1350 Albert Street, Regina, SK S4R 2R7, Canada;
| | - William Johnston
- Ottawa Paramedic Service, 2465 Don Reid Drive, Ottawa, ON K1H 1E2, Canada; (W.J.)
| | - Chelsea Lanos
- Department of Paramedicine, Monash University, Building H, Peninsula Campus, 47–49 Moorooduc Hwy, Frankston, VIC 3199, Australia; (J.L.B.); or (C.C.); (C.L.); (T.M.L.)
| | - Tyne M. Lunn
- Department of Paramedicine, Monash University, Building H, Peninsula Campus, 47–49 Moorooduc Hwy, Frankston, VIC 3199, Australia; (J.L.B.); or (C.C.); (C.L.); (T.M.L.)
| | - Paige Mason
- Ottawa Paramedic Service, 2465 Don Reid Drive, Ottawa, ON K1H 1E2, Canada; (W.J.)
- School of Interdisciplinary Studies, Royal Roads University, 2005 Sooke Road, Victoria, BC V9B 5Y2, Canada
| | - Sean Teed
- School of Paramedicine, Medavie HealthEd, 50 Eileen Stubbs Avenue, Unit 154, Dartmouth, NS B3B 0M7, Canada;
| | - Charlene Vacon
- Regional Paramedic Program for Eastern Ontario, The Ottawa Hospital, 2475 Don Reid Drive, Ottawa, ON K1H 1E2, Canada;
| | - Walter Tavares
- Department of Health and Society & Wilson Centre for Health Professions Education Research, University of Toronto, 1265 Military Trail, Toronto, ON M1C1A4, Canada;
- York Region Paramedic Services, 80 Bales Drive East, East Gwillimbury, ON L0G 1V, Canada
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Strum RP, Mowbray FI, Zargoush M, Jones AP. Prehospital prediction of hospital admission for emergent acuity patients transported by paramedics: A population-based cohort study using machine learning. PLoS One 2023; 18:e0289429. [PMID: 37616228 PMCID: PMC10449470 DOI: 10.1371/journal.pone.0289429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/18/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION The closest emergency department (ED) may not always be the optimal hospital for certain stable high acuity patients if further distanced ED's can provide specialized care or are less overcrowded. Machine learning (ML) predictions may support paramedic decision-making to transport a subgroup of emergent patients to a more suitable, albeit more distanced, ED if hospital admission is unlikely. We examined whether characteristics known to paramedics in the prehospital setting were predictive of hospital admission in emergent acuity patients. MATERIALS AND METHODS We conducted a population-level cohort study using four ML algorithms to analyze ED visits of the National Ambulatory Care Reporting System from January 1, 2018 to December 31, 2019 in Ontario, Canada. We included all adult patients (≥18 years) transported to the ED by paramedics with an emergent Canadian Triage Acuity Scale score. We included eight characteristic classes as model predictors that are recorded at ED triage. All ML algorithms were trained and assessed using 10-fold cross-validation to predict hospital admission from the ED. Predictive model performance was determined using the area under curve (AUC) with 95% confidence intervals and probabilistic accuracy using the Brier Scaled score. Variable importance scores were computed to determine the top 10 predictors of hospital admission. RESULTS All machine learning algorithms demonstrated acceptable accuracy in predicting hospital admission (AUC 0.77-0.78, Brier Scaled 0.22-0.24). The characteristics most predictive of admission were age between 65 to 105 years, referral source from a residential care facility, presenting with a respiratory complaint, and receiving home care. DISCUSSION Hospital admission was accurately predicted based on patient characteristics known prehospital to paramedics prior to arrival. Our results support consideration of policy modification to permit certain emergent acuity patients to be transported to a further distanced ED. Additionally, this study demonstrates the utility of ML in paramedic and prehospital research.
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Affiliation(s)
- Ryan P. Strum
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Fabrice I. Mowbray
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- College of Nursing, Michigan State University, East Lansing, Michigan, United States of America
| | - Manaf Zargoush
- Department of Health Policy and Management, McMaster University, Hamilton, Ontario, Canada
| | - Aaron P. Jones
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Institute for Clinical Evaluative Sciences, McMaster University, Hamilton, Ontario, Canada
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Louras N, Reading Turchioe M, Shafran Topaz L, Demetres MR, Ellison M, Abudu-Solo J, Blutinger E, Munjal KG, Daniels B, Masterson Creber RM. Mobile Integrated Health Interventions for Older Adults: A Systematic Review. Innov Aging 2023; 7:igad017. [PMID: 37090165 PMCID: PMC10114527 DOI: 10.1093/geroni/igad017] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Indexed: 03/04/2023] Open
Abstract
Background and Objectives Mobile integrated health (MIH) interventions have not been well described in older adult populations. The objective of this systematic review was to evaluate the characteristics and effectiveness of MIH programs on health-related outcomes among older adults. Research Design and Methods We searched Ovid MEDLINE, Ovid EMBASE, CINAHL, AgeLine, Social Work Abstracts, and The Cochrane Library through June 2021 for randomized controlled trials or cohort studies evaluating MIH among adults aged 65 and older in the general community. Studies were screened for eligibility against predefined inclusion/exclusion criteria. Using at least 2 independent reviewers, quality was appraised using the Downs and Black checklist and study characteristics and findings were synthesized and evaluated for potential bias. Results Screening of 2,160 records identified 15 studies. The mean age of participants was 67 years. The MIH interventions varied in their focus, community paramedic training, types of assessments and interventions delivered, physician oversight, use of telemedicine, and post-visit follow-up. Studies reported significant reductions in emergency call volume (5 studies) and immediate emergency department (ED) transports (3 studies). The 3 studies examining subsequent ED visits and 4 studies examining readmission rates reported mixed results. Studies reported low adverse event rates (5 studies), high patient and provider satisfaction (5 studies), and costs equivalent to or less than usual paramedic care (3 studies). Discussion and Implications There is wide variability in MIH provider training, program coordination, and quality-based metrics, creating heterogeneity that make definitive conclusions challenging. Nonetheless, studies suggest MIH reduces emergency call volume and ED transport rates while improving patient experience and reducing overall health care costs.
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Affiliation(s)
- Nathan Louras
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Leah Shafran Topaz
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Michelle R Demetres
- Samuel J. Wood Library and C.V. Starr Biomedical Information Center, Weill Cornell Medical College, New York, New York, USA
| | - Melani Ellison
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Jamie Abudu-Solo
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Erik Blutinger
- Department of Emergency Medicine, Mount Sinai Icahn School of Medicine, New York, New York, USA
| | - Kevin G Munjal
- Department of Emergency Medicine, Mount Sinai Icahn School of Medicine, New York, New York, USA
| | - Brock Daniels
- Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, USA
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Vuilleumier S, Spichiger T, Dénéréaz S, Fiorentino A. Not only COVID-19 disease impacts ambulance emergency demands but also lockdowns and quarantines. BMC Emerg Med 2023; 23:4. [PMID: 36635638 PMCID: PMC9836922 DOI: 10.1186/s12873-023-00772-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/02/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The pandemic has impacted both patients infected by the SARS-CoV-2 virus and patients who seek emergency assistance due to other health issues. Changes in emergency demands are expected to have occurred during the pandemic, the objective of this investigation is to characterize the changes in ambulance emergency demands during the first year of the COVID-19 pandemic in the Vaud State of Switzerland. The goal of this research is to identify the collateral effects of the COVID-19 pandemic on emergency demands. To do so, this study quantifies the differences in health issues, level of severity, and patients' sociodemographic characteristics (age, location, gender) prior to and during the outbreak. METHOD This is a retrospective, descriptive and comparative statistical analysis of all ambulance emergency missions from 2018 to 2020 (n = 107,150) in the State of Vaud in Switzerland. Variables analyzed were the number of ambulance missions, patient age and gender, health issues, severity (NACA scores), number of non-transports, mission times and locations. Variables were compared between prepandemic and pandemic situations across years and months. Comparative analysis used bivariate analysis, χ2 test, Student's t test, and Mann‒Whitney U test. RESULTS The pandemic has had two major impacts on the population's emergency demands. The first appears to be due to COVID-19, with an increase in respiratory distress cases that doubled in November 2020. The second relates to the implementation of lockdown and quarantine measures for the population and the closures of restaurants and bars. These might explain the decrease in both the number of traumas and intoxications, reaching more than 25% and 28%, respectively. An increase in prehospital emergency demands by the older population, which accounted for 53% of all demands in 2020, is measured. CONCLUSION Collateral effects occurred during 2020 and were not only due to the pandemic but also due to protective measures deployed relative to the population. This work suggests that more targeted reflections and interventions concerning the most vulnerable group, the population of people 65 and older, should be of high priority. Gaining generalizable knowledge from the COVID-19 pandemic in prehospital settings is critical for the management of future pandemics or other unexpected disasters.
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Affiliation(s)
- Séverine Vuilleumier
- La Source School of Nursing, University of Applied Sciences and Art Western Switzerland (HES-SO), Lausanne, CH-1004 Switzerland
| | - Thierry Spichiger
- grid.507562.3ES ASUR, Vocational Training College for Registered Paramedics and Emergency Care, Le Mont- sur-Lausanne, CH-1052 Switzerland
| | - Sandrine Dénéréaz
- grid.507562.3ES ASUR, Vocational Training College for Registered Paramedics and Emergency Care, Le Mont- sur-Lausanne, CH-1052 Switzerland
| | - Assunta Fiorentino
- La Source School of Nursing, University of Applied Sciences and Art Western Switzerland (HES-SO), Lausanne, CH-1004 Switzerland
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Strum RP, Tavares W, Worster A, Griffith LE, Costa AP. Inclusion of patient-level emergency department characteristics to classify potentially redirectable visits to subacute care: a modified Delphi consensus study. CMAJ Open 2023; 11:E70-E76. [PMID: 36693658 PMCID: PMC9876581 DOI: 10.9778/cmajo.20220062] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Most patients transported by Ontario paramedics to the emergency department have non-emergent conditions and may be more appropriately served by subacute community-based care centres. We sought to determine consensus on a set of patient characteristics that could be useful to classify retrospective emergency department visits that had a high probability of being primary care-like and potentially redirectable to a subacute care centre by paramedics. METHODS We conducted a modified Delphi study to assess expert consensus on characteristics of patients transported by paramedics to the emergency department from August to October 2021. An expert Delphi committee was constructed of emergency and family physicians in Ontario using purposive sampling. Experts rated whether each characteristic was useful to be included in a classification to identify potentially redirectable visits retrospectively, as well as characteristic details (e.g., upper and lower bounds). Consensus was considered 75% agreement. RESULTS Sixteen experts participated in the study; the experts were mostly male (75%) and evenly divided between emergency and family medicine. After 2 rounds, consensus was achieved on 8 of 9 characteristics (89%). Four characteristics were determined as useful to classify potentially redirectable emergency department visits: age (81%), triage acuity (100%), specialist consult in the emergency department (94%) and emergency department visit outcome (81%). Specifications of each characteristic were refined as follows: young and middle-aged adults with a non-emergent triage acuity, did not receive a specialist physician consult in the emergency department and discharged from the emergency department. INTERPRETATION Strong consensus was achieved to specify a classification system for potentially redirectable emergency department visits. These results will be combined with knowledge of which subacute care centres could conduct the main physician interventions to retrospectively identify emergency department visits that could have been suitable for paramedic redirection for further research. STUDY REGISTRATION ID ISRCTN22901977.
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Affiliation(s)
- Ryan P Strum
- Department of Health Research Methods, Evidence, and Impact (Strum, Worster, Griffith, Costa), McMaster University, Hamilton, Ont.; The Wilson Centre (Tavares), University of Toronto, Toronto, Ont.; York Region Paramedic and Senior Services (Tavares), Regional Municipality of York, Newmarket, Ont.; McMaster Institute for Research and Aging (Griffith), and Division of Emergency Medicine (Worster), Department of Medicine, and Department of Medicine (Costa), McMaster University, Hamilton, Ont.
| | - Walter Tavares
- Department of Health Research Methods, Evidence, and Impact (Strum, Worster, Griffith, Costa), McMaster University, Hamilton, Ont.; The Wilson Centre (Tavares), University of Toronto, Toronto, Ont.; York Region Paramedic and Senior Services (Tavares), Regional Municipality of York, Newmarket, Ont.; McMaster Institute for Research and Aging (Griffith), and Division of Emergency Medicine (Worster), Department of Medicine, and Department of Medicine (Costa), McMaster University, Hamilton, Ont
| | - Andrew Worster
- Department of Health Research Methods, Evidence, and Impact (Strum, Worster, Griffith, Costa), McMaster University, Hamilton, Ont.; The Wilson Centre (Tavares), University of Toronto, Toronto, Ont.; York Region Paramedic and Senior Services (Tavares), Regional Municipality of York, Newmarket, Ont.; McMaster Institute for Research and Aging (Griffith), and Division of Emergency Medicine (Worster), Department of Medicine, and Department of Medicine (Costa), McMaster University, Hamilton, Ont
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact (Strum, Worster, Griffith, Costa), McMaster University, Hamilton, Ont.; The Wilson Centre (Tavares), University of Toronto, Toronto, Ont.; York Region Paramedic and Senior Services (Tavares), Regional Municipality of York, Newmarket, Ont.; McMaster Institute for Research and Aging (Griffith), and Division of Emergency Medicine (Worster), Department of Medicine, and Department of Medicine (Costa), McMaster University, Hamilton, Ont
| | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact (Strum, Worster, Griffith, Costa), McMaster University, Hamilton, Ont.; The Wilson Centre (Tavares), University of Toronto, Toronto, Ont.; York Region Paramedic and Senior Services (Tavares), Regional Municipality of York, Newmarket, Ont.; McMaster Institute for Research and Aging (Griffith), and Division of Emergency Medicine (Worster), Department of Medicine, and Department of Medicine (Costa), McMaster University, Hamilton, Ont
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Strum RP, Mondoux S, Mowbray F, Worster A, Griffith LE, Tavares W, Miller P, Hanel E, Aryal K, Sivakumaran R, Costa AP. Validation of a classification to identify emergency department visits suitable for subacute and virtual care models: a randomised single-blinded agreement study protocol. BMJ Open 2022; 12:e068488. [PMID: 36526315 PMCID: PMC9764606 DOI: 10.1136/bmjopen-2022-068488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Redirecting suitable patients from the emergency department (ED) to alternative subacute settings may assist in reducing ED overcrowding while delivering equivalent care. The Emergency Department Avoidance Classification (EDAC) was constructed to retrospectively classify ED visits that may have been suitable for safe management in a subacute or virtual clinical setting. The EDAC has established face and content validity but has not been tested against a reference standard as a criterion. OBJECTIVES Our primary objective is to examine the agreement between the EDAC and ED physician judgements in retrospectively identifying ED visits suitable for subacute care management. Our secondary objective is to assess the validity of ED physicians' judgement as a criterion standard. Our tertiary objective is to examine how the ED physician's perception of a virtual ED care alternative correlates with the EDAC. METHODS AND ANALYSIS A randomised single-centre, single-blinded agreement study. We will randomly select ED charts between 1 January and 31 December 2019 from an academic hospital in Hamilton, Canada. ED charts will be randomly assigned to participating ED physicians who will evaluate if this ED visit could have been managed appropriately and safely in a subacute and/or virtual model of care. Each chart will be reviewed by two physicians independently. We compute our needed sample size to be 79 charts. We will use kappa statistics to measure inter-rater agreement. A repeated measures regression model of physician ratings will provide variance estimates that we will use to assess the intraclass correlation of ED physician ratings and the EDAC. ETHICS AND DISSEMINATION This study has been approved by the Hamilton Integrated Research Ethics Board (2022-14625). If validated, the EDAC may provide an ED-based classification to identify potentially avoidable ED visits, monitor ED visit trends, and proactively delineate those best suited for subacute or virtual care models.
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Affiliation(s)
- Ryan P Strum
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Shawn Mondoux
- Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Fabrice Mowbray
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrew Worster
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lauren E Griffith
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- McMaster Institute for Research and Aging, McMaster University, Hamilton, Ontario, Canada
| | - Walter Tavares
- The Wilson Centre, University of Toronto, Toronto, Ontario, Canada
| | - Paul Miller
- Medicine, McMaster University, Hamilton, Ontario, Canada
- Centre for Paramedic Education and Research, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Erich Hanel
- Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Komal Aryal
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ravi Sivakumaran
- Health Information Management, Saint Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Andrew P Costa
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Strum RP, Drennan IR, Mowbray FI, Mondoux S, Worster A, Babe G, Costa AP. Increased demand for paramedic transports to the emergency department in Ontario, Canada: a population-level descriptive study from 2010 to 2019. CAN J EMERG MED 2022; 24:742-750. [PMID: 35984572 PMCID: PMC9389513 DOI: 10.1007/s43678-022-00363-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022]
Abstract
Purpose We examined changes in annual paramedic transport incidence over the ten years prior to COVID-19 in comparison to increases in population growth and emergency department (ED) visitation by walk-in. Methods We conducted a population-level cohort study using the National Ambulatory Care Reporting System from January 1, 2010 to December 31, 2019 in Ontario, Canada. We included all patients triaged in the ED who arrived by either paramedic transport or walk-in. We clustered geographical regions using the Local Health Integration Network boundaries. Descriptive statistics, rate ratios (RR), and 95% confidence intervals were calculated to explore population-adjusted changes in transport volumes. Results Overall incidence of paramedic transports increased by 38.3% (n = 264,134), exceeding population growth fourfold (9.4%) and walk-in ED visitation threefold (13.4%). Population-adjusted transport rates increased by 26.2% (rate ratio 1.26, 95% CI 1.26–1.27) compared to 3.4% for ED visit by walk-in (rate ratio 1.03, 95% CI 1.03–1.04). Patient and visit characteristics remained consistent (age, gender, triage acuity, number of comorbidities, ED disposition, 30-day repeat ED visits) across the years of study. The majority of transports in 2019 had non-emergent triage scores (60.0%) and were discharged home directly from the ED (63.7%). The largest users were persons aged 65 or greater (43.7%). The majority of transports occurred in urbanized regions, though rural and northern regions experienced similar paramedic transport growth rates. Conclusion There was a substantial increase in the demand for paramedic transportation. Growth in paramedic demand outpaced population growth markedly and may continue to surge alongside population aging. Increases in the rate of paramedic transports per population were not bound to urbanized regions, but were province-wide. Our findings indicate a mounting need to develop innovative solutions to meet the increased demand on paramedic services and to implement long-term strategies across provincial paramedic systems.
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Affiliation(s)
- Ryan P Strum
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
| | - Ian R Drennan
- Department of Family and Community Medicine, Division of Emergency Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Sunnybrook Research Institute, Sunnybrook Hospital, Toronto, ON, Canada
| | - Fabrice I Mowbray
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Shawn Mondoux
- Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Andrew Worster
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada
| | - Glenda Babe
- Institute for Clinical Evaluative Sciences, McMaster University, Hamilton, ON, Canada
| | - Andrew P Costa
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
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Tohira H, Masters S, Ngo H, Bailey P, Ball S, Finn J, Arendts G. Descriptive Study of Ambulance Attendances for Older Adults with and without Dementia in Western Australia. PREHOSP EMERG CARE 2022; 27:851-858. [PMID: 35771727 DOI: 10.1080/10903127.2022.2096947] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/20/2022] [Accepted: 06/28/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To describe and compare characteristics of ambulance attendances for older adults with and without dementia. METHODS A retrospective cohort study was conducted using electronic patient care records from the main ambulance service in Western Australia. All attendances for people aged 65 years or older in the years 2019-21 were included. Dementia status was adjudicated from the clinical history and medication lists. Patient and case characteristics of those with and without dementia were compared and stratified by type of residence. RESULTS There were 277,996 emergency ambulance attendances made by 124,711 older adults, of whom 23.5% had dementia. The mean number of attendances per person was 3.3 in the dementia cohort vs 2.0 in those without dementia. Falls were the leading reason for ambulance attendance. People with dementia were significantly frailer, required longer at-scene intervals, were less likely to be transported as the highest priority, and had lower 30-day survival. CONCLUSIONS Dementia is common amongst older adults attended by paramedics and is associated with higher ambulance utilization per person. People with dementia attended by paramedics have stronger signals of vulnerability, such as increased frailty. As the number of people living with dementia increases in the future, there are implications for workforce training and service planning. There are opportunities for developing alternatives to emergency department transportation for some people with dementia.
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Affiliation(s)
- Hideo Tohira
- Prehospital, Resuscitation and Emergency Care Research Unit, Curtin School of Nursing, Curtin University, Perth, WA, Australia
- Discipline of Emergency Medicine, Medical School, The University of Western Australia, Perth, WA, Australia
| | - Stacey Masters
- Prehospital, Resuscitation and Emergency Care Research Unit, Curtin School of Nursing, Curtin University, Perth, WA, Australia
| | - Hanh Ngo
- Prehospital, Resuscitation and Emergency Care Research Unit, Curtin School of Nursing, Curtin University, Perth, WA, Australia
- Discipline of Emergency Medicine, Medical School, The University of Western Australia, Perth, WA, Australia
| | - Paul Bailey
- St John Western Australia, Belmont, WA, Australia
| | - Stephen Ball
- Prehospital, Resuscitation and Emergency Care Research Unit, Curtin School of Nursing, Curtin University, Perth, WA, Australia
- St John Western Australia, Belmont, WA, Australia
| | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit, Curtin School of Nursing, Curtin University, Perth, WA, Australia
- Discipline of Emergency Medicine, Medical School, The University of Western Australia, Perth, WA, Australia
- St John Western Australia, Belmont, WA, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Glenn Arendts
- Discipline of Emergency Medicine, Medical School, The University of Western Australia, Perth, WA, Australia
- Emergency Department, Fiona Stanley Hospital, Murdoch, WA, Australia
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