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Hauch H, El Mohaui N, Sander M, Rellensmann G, Berthold D, Kriwy P, Zernikow B, Wager J, Schneck E. Implementation and evaluation of a palliative care training unit for EMS providers. Front Pediatr 2023; 11:1272706. [PMID: 37830055 PMCID: PMC10565227 DOI: 10.3389/fped.2023.1272706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/18/2023] [Indexed: 10/14/2023] Open
Abstract
Background The prevalence of children with life-limiting conditions (LLCs) is rising. It is characteristic for these children to require 24/7 care. In emergencies, families must decide to call the emergency medical service (EMS) or a palliative care team (PCT)-if available. For EMS teams, an emergency in a child with an LLC is a rare event. Therefore, EMS providers asked for a training unit (TU) to improve their knowledge and skills in pediatric palliative care. Aim of the study The questions were as follows: whether a TU is feasible, whether its integration into the EMS training program was accepted, and whether an improvement of knowledge can be achieved. Methods We designed and implemented a brief TU based on findings of a previous study that included 1,005 EMS providers. The topics covered were: (1) basics in palliative home care, (2) theoretical aspects, and (3) practical aspects. After participating in the TU, the participants were given a questionnaire to re-evaluate their learning gains and self-confidence in dealing with emergencies in pediatric patients with LLC. Results 782 (77.8%) of 1,005 participants of the previous study responded to the questionnaire. The average age was 34.9 years (±10.7 years SD), and 75.3% were male. The average work experience was 11.4 years (±9.5 years SD), and 15.2% were medical doctors. We found an increase in theoretical knowledge and enhanced self-confidence in dealing with emergencies in patients with LLC (confidence: before training: 3.3 ± 2.0 SD; after training: 5.7 ± 2.1 SD; min.: 1; max.: 10; p < 0.001). The participants changed their approaches to a fictitious case report from more invasive to less invasive treatment. Most participants wanted to communicate directly with PCTs and demanded a standard operating procedure (SOP) for treating patients with LLC. We discussed a proposal for an SOP with the participants. Conclusion EMS providers want to be prepared for emergencies in children with LLCs. A brief TU can improve their knowledge and confidence to handle these situations adequately. This TU is the first step to improve collaboration between PCTs and EMS teams.
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Affiliation(s)
- Holger Hauch
- Department of Children’s Pain Therapy and Pediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
- Palliative Care Team for Children, University Children’s Hospital, Giessen, Hesse, Germany
| | - Naual El Mohaui
- Palliative Care Team for Children, University Children’s Hospital, Giessen, Hesse, Germany
| | - Michael Sander
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital, Giessen, Hesse, Germany
| | - Georg Rellensmann
- Department of Children’s Pain Therapy and Pediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Daniel Berthold
- Department for Medical Oncology and Palliative Care, University Hospital of Giessen and Marburg, Giessen Site, Germany
| | - Peter Kriwy
- Institute for Sociology, Technical University of Chemnitz, Chemnitz, Saxony, Germany
| | - Boris Zernikow
- Department of Children’s Pain Therapy and Pediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
- PedScience Research Institute, Datteln, Germany
| | - Julia Wager
- Department of Children’s Pain Therapy and Pediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
- PedScience Research Institute, Datteln, Germany
| | - Emmanuel Schneck
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital, Giessen, Hesse, Germany
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Kontunen P, Holstein R, Castrén M, Carter A. Optimal acute care for long-term care patients: from emergency department to home. CAN J EMERG MED 2023; 25:259-260. [PMID: 37036610 DOI: 10.1007/s43678-023-00488-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Affiliation(s)
- Perttu Kontunen
- Department of Public Health, Helsinki University, Yliopistonkatu 4, 00100, Helsinki, Finland.
- Department of Emergency Medicine and Services, Helsinki University and Helsinki University Hospital, Helsinki, Finland.
| | - Ria Holstein
- Department of Public Health, Helsinki University, Yliopistonkatu 4, 00100, Helsinki, Finland
- Department of Emergency Medicine and Services, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Maaret Castrén
- Department of Emergency Medicine and Services, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Alix Carter
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
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Alternative care models for paramedic patients from long-term care centers: a national survey of Canadian paramedic services. CAN J EMERG MED 2023; 25:344-352. [PMID: 36897539 DOI: 10.1007/s43678-023-00471-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 02/10/2023] [Indexed: 03/11/2023]
Abstract
INTRODUCTION Long-term care (LTC) patients do poorly when transported to emergency departments (ED). Community paramedic programs deliver enhanced care in their place of residence, yet few programs are reported in the literature. We conducted a national cross-sectional survey of land ambulance services to understand if such programs exist in Canada, and what the perceived needs and priorities are for future programs. METHODS We emailed a 46 question survey to paramedic services across Canada. We asked about service characteristics, current ED diversion programs, existing diversion programs specific to LTC patients, priorities for future programs, the potential impact of such programs, and what the feasibility and barriers are to implementing programs that treat LTC patients on-site, avoiding an ED visit. RESULTS We received responses from 50 sites across Canada, providing services to 73.5% of the total population. Almost a third (30.0%) had existing treat-and-refer programs, and 65.5% of services transported to destinations other than an ED. Almost all respondents (98.0%) felt the need for programs to treat LTC patients on-site, and 36.0% had existing programs. The top priorities for future programs were support for patients being discharged (30.6%), extended care paramedics (24.5%), and respiratory illness treat-in-place programs (20.4%). The highest potential impact was expected from support for patients being discharged (62.0%) and respiratory illness treat-in-place programs (54.0%). Required changes in legislation (36.0%) and required changes to the system of medical oversight (34.0%) were identified as top barriers to implementing such programs. CONCLUSION There is a significant mismatch between the perceived need for community paramedic programs treating LTC patients on-site, and the number of programs in place. Programs could benefit from standardized outcome measurement and the publication of peer-reviewed evidence to guide future programs. Changes in legislation and medical oversight are needed to address the identified barriers to program implementation.
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Hauch H, El Mohaui N, Vaillant V, Sander M, Kriwy P, Rohde M, Wolff J, Berthold D, Schneck E. Prehospital emergency medicine for children receiving palliative home care in Germany-a cross-sectional, exploratory study of EMS providers. Front Pediatr 2023; 11:1104655. [PMID: 36865689 PMCID: PMC9971952 DOI: 10.3389/fped.2023.1104655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/24/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND The prevalence of children with life-limiting conditions is rising, and since the amendment of the social insurance code in Germany, palliative home care teams have treated an increasing number of children. These teams provide 24/7 readiness, yet some parents still call the general emergency medical service (EMS) for various reasons. EMS is exposed to complex medical problems in rare diseases. Questions arose about the experiences of EMS and whether they felt prepared for emergencies involving children treated by a palliative care team. METHODS This study used a mixed methods approach to focus on the interface between palliative care and EMS. First, open interviews were conducted, and a questionnaire was developed based on the results. The variables included demographic items and individual experiences with patients. Second, a case report of a child with respiratory insufficiency was presented to assess the spontaneous treatment intentions of EMS providers. Finally, the need, relevant topics, and duration of specific training in palliative care for EMS providers were evaluated. RESULTS In total, 1,005 EMS providers responded to the questionnaire. The average age was 34.5 years (±10.94SD), 74.6% were male. The average work experience was 11.8 years (±9.7), 21.4% were medical doctors. Experience with a call of a life-threatening emergency involving a child was reported by 61.5% and severe psychological distress during such a call was reported by 60.4%. The equivalent distress frequency for adult patient calls was 38.3%. (p < 0.001). After review of the case report, the EMS respondents suggested invasive treatment options and rapid transport to the hospital. Most (93.7%) respondents welcomed the consideration of special training in pediatric palliative care. This training should include basic information about palliative care, an analysis of cases involving palliatively treated children, an ethical perspective, practical recommendations, and available (24/7) local contact for further guidance and support. CONCLUSION Emergencies in pediatric palliatively treated patients were more common than expected. EMS providers perceived the situations as stressful, and there is a need for specific training with practical aspects.
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Affiliation(s)
- Holger Hauch
- Palliative Care Team for Children, University Children's Hospital, Giessen, Hesse, Germany.,University Children's Hospital Giessen, Department of Pediatric Oncology, Giessen, Hesse, Germany
| | - Naual El Mohaui
- Palliative Care Team for Children, University Children's Hospital, Giessen, Hesse, Germany
| | - Vera Vaillant
- Palliative Care Team for Children, University Children's Hospital, Giessen, Hesse, Germany
| | - Michael Sander
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital, Giessen, Hesse, Germany
| | - Peter Kriwy
- Institute of Sociology, University of Technology, Chemnitz, Saxony, Germany
| | - Marius Rohde
- University Children's Hospital Giessen, Department of Pediatric Oncology, Giessen, Hesse, Germany
| | - Johannes Wolff
- Department of Oncology, Cleveland Clinic, Pediatric Oncology, Cleveland, OH, United States
| | - Daniel Berthold
- University Hospital Giessen, Palliative Care Team for Adults, Giessen, Hesse, Germany
| | - Emmanuel Schneck
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital, Giessen, Hesse, Germany
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Allana A, Tavares W, Pinto AD, Kuluski K. Designing and Governing Responsive Local Care Systems - Insights from a Scoping Review of Paramedics in Integrated Models of Care. Int J Integr Care 2022; 22:5. [PMID: 35509960 PMCID: PMC9009364 DOI: 10.5334/ijic.6418] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 03/28/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Programs that fill gaps in fractured health and social services in response to local needs can provide insight on enacting integrated care. Grassroots programs and the changing roles of paramedics within them were analyzed to explore how the health workforce, organizations and governance could support integrated care. Methods A study was conducted following Arksey and O'Malley's method for scoping reviews, using Valentijn's Rainbow Model of Integrated Care as an organizing framework. Qualitative content analysis was done on clinical, professional, organizational, system, functional and normative aspects of integration. Common patterns, challenges and gaps were documented. Results After literature search and screening, 137 documents with 108 unique programs were analysed. Paramedics bridge reactive and preventative care for a spectrum of population needs through partnerships with hospitals, social services, primary care and public health. Programs encountered challenges with role delineation, segregated organizations, regulation and tensions in professional norms. Discussion Five concepts were identified for fostering integrated care in local systems: single point-of-entry care pathways; flexible and mobile workforce; geographically-based cross-cutting organizations; permissive regulation; and assessing system-level value. Conclusion Integrated care may be supported by a generalist health workforce, through cross-cutting organizations that work across silos, and legislation that balances standardization with flexibility.
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Affiliation(s)
- Amir Allana
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, CA
- McNally Project for Paramedicine Research, CA
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, CA
| | - Walter Tavares
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, CA
- McNally Project for Paramedicine Research, CA
- The Wilson Centre and Temerty Faculty of Medicine, University of Toronto|University Health Network, CA
- York Region Paramedic Services, Community and Health Services Department, The Regional Municipality of York, CA
| | - Andrew D. Pinto
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, CA
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, CA
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, CA
| | - Kerry Kuluski
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, CA
- Institute for Better Health, Trillium Health Partners, CA
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6
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Juhrmann ML, Vandersman P, Butow PN, Clayton JM. Paramedics delivering palliative and end-of-life care in community-based settings: A systematic integrative review with thematic synthesis. Palliat Med 2022; 36:405-421. [PMID: 34852696 PMCID: PMC8972966 DOI: 10.1177/02692163211059342] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is a growing demand for community palliative care and home-based deaths worldwide. However, gaps remain in this service provision, particularly after-hours. Paramedicine may help to bridge that gap and avoid unwanted hospital admissions, but a systematic overview of paramedics' potential role in palliative and end-of-life care is lacking. AIM To review and synthesise the empirical evidence regarding paramedics delivering palliative and end-of-life care in community-based settings. DESIGN A systematic integrative review with a thematic synthesis was undertaken in accordance with Whittemore and Knafl's methodology. Prospero: CRD4202119851. DATA SOURCES MEDLINE, CINAHL, PsycINFO and Scopus databases were searched in August 2020 for primary research articles published in English, with no date limits applied. Articles were screened and reviewed independently by two researchers, and quality appraisal was conducted following the Mixed-Methods Appraisal Tool (2018). RESULTS The search retrieved 5985 articles; 23 articles satisfied eligibility criteria, consisting of mixed-methods (n = 5), qualitative (n = 7), quantitative descriptive (n = 8) and quantitative non-randomised studies (n = 3). Through data analysis, three key themes were identified: (1) Broadening the traditional role, (2) Understanding patient wishes and (3) Supporting families. CONCLUSIONS Paramedics are a highly skilled workforce capable of helping to deliver palliative and end-of-life care to people in their homes and reducing avoidable hospital admissions, particularly for palliative emergencies. Future research should focus on investigating the efficacy of palliative care clinical practice guideline implementation for paramedics, understanding other healthcare professionals' perspectives, and undertaking health economic evaluations of targeted interventions.
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Affiliation(s)
- Madeleine L Juhrmann
- Northern Clinical School, University of Sydney, Sydney, NSW, Australia.,HammondCare Centre for Learning and Research in Palliative Care, Greenwich Hospital, Greenwich, NSW, Australia
| | - Priyanka Vandersman
- Research Centre for Palliative Care, Death and Dying, Flinders University of South Australia, Adelaide, SA, Australia
| | - Phyllis N Butow
- Psycho-oncology Co-operative Research Group and Centre for Medical Psychology and Evidence-based Decision-making, University of Sydney, Sydney, NSW, Australia
| | - Josephine M Clayton
- Northern Clinical School, University of Sydney, Sydney, NSW, Australia.,HammondCare Centre for Learning and Research in Palliative Care, Greenwich Hospital, Greenwich, NSW, Australia
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Munene A, Alaazi D, Mathew J, McLane P, Cummings G, Holroyd-Leduc J. Impact of community paramedic interventions on transfers from long term care to emergency departments: results of a systematic review. CAN J EMERG MED 2022; 24:101-102. [PMID: 34648170 DOI: 10.1007/s43678-021-00214-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Abraham Munene
- Cumming School of Medicine, University of Calgary (Foothills Campus), South Tower, 1403-29 Street NW T2N 4N1, Calgary, AB, Canada.
| | - Dominic Alaazi
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Jane Mathew
- Cumming School of Medicine, University of Calgary (Foothills Campus), South Tower, 1403-29 Street NW T2N 4N1, Calgary, AB, Canada
| | | | - Greta Cummings
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Jayna Holroyd-Leduc
- Cumming School of Medicine, University of Calgary (Foothills Campus), South Tower, 1403-29 Street NW T2N 4N1, Calgary, AB, Canada
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Community nurse-paramedics' sphere of practice in primary care; an ethnographic study. BMC Health Serv Res 2021; 21:710. [PMID: 34275436 PMCID: PMC8286441 DOI: 10.1186/s12913-021-06691-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 06/23/2021] [Indexed: 11/15/2022] Open
Abstract
Background Primary care, the principal function of the health care system, requires effort from all local primary health care teams. Community Paramedicine (CP) has managed to reduce the use of Emergency Medical Services (EMS) for non-emergency calls, but for the paramedic to move from traditional emergency calls to non-emergency care will mean new demands. There is a paucity of research exploring nurse-paramedics’ experiences and perceptions of their novel roles as community paramedics in Finland. This study aims to explore the community nurse-paramedics’ (CNP) experiences in their new sphere of practice. Methods A descriptive ethnographic study was conducted, to collect data through participant observation (317 h total) and semi-structured interviews (N = 22) in three hospital districts (HD) where the CNPs have worked for at least 1 year. Both data sets were combined, organised, and analysed using inductive content analysis. Results Five main categories were developed by applying inductive content analysis: the new way of thinking, the broad group of patients, the way to provide care, the diversity of multidisciplinary collaboration, and tailored support from the organisation. The CNP was identified as needing an appropriate attitude towards care and a broader way of thinking compared to the traditional practice of taking care of the patient and the family members. The diversity of multidisciplinary collaboration teams can be a sensitive but worthwhile topic for offering new possibilities. Tailored support from the organisation includes tools for future CP models. Conclusions Our results indicate the CNPs’ deep involvement in patients’ and families’ care needs and challenges with their skills and competencies. Their professional attitudes and eagerness to develop and maintain multidisciplinary collaboration can offer preventive and long-term caring solutions from which citizens, allied health, safety, and social care providers benefit locally and globally.
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James HSE, Smith AC, Thomas EE, Snoswell CL, Caffery LJ, Haydon HM. Exploring paramedics’ intention to use a specialist palliative care telehealth service. PROGRESS IN PALLIATIVE CARE 2021. [DOI: 10.1080/09699260.2020.1852657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
| | - A. C. Smith
- Centre for Online Health, The University of Queensland, Princess Alexandra Hospital, Ground Floor, Building 33, Woolloongabba, QLD 4102, Australia
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital, Ground Floor, Building 33, Woolloongabba, QLD 4102, Australia
| | - E. E. Thomas
- Centre for Online Health, The University of Queensland, Princess Alexandra Hospital, Ground Floor, Building 33, Woolloongabba, QLD 4102, Australia
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital, Ground Floor, Building 33, Woolloongabba, QLD 4102, Australia
| | - C. L. Snoswell
- Centre for Online Health, The University of Queensland, Princess Alexandra Hospital, Ground Floor, Building 33, Woolloongabba, QLD 4102, Australia
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital, Ground Floor, Building 33, Woolloongabba, QLD 4102, Australia
| | - L. J. Caffery
- Centre for Online Health, The University of Queensland, Princess Alexandra Hospital, Ground Floor, Building 33, Woolloongabba, QLD 4102, Australia
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital, Ground Floor, Building 33, Woolloongabba, QLD 4102, Australia
| | - H. M. Haydon
- Centre for Online Health, The University of Queensland, Princess Alexandra Hospital, Ground Floor, Building 33, Woolloongabba, QLD 4102, Australia
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital, Ground Floor, Building 33, Woolloongabba, QLD 4102, Australia
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Alternatives to direct emergency department conveyance of ambulance patients: a scoping review of the evidence. Scand J Trauma Resusc Emerg Med 2021; 29:4. [PMID: 33407771 PMCID: PMC7789540 DOI: 10.1186/s13049-020-00821-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/02/2020] [Indexed: 12/02/2022] Open
Abstract
Background The role of ambulance services is shifting, due in part to more intermediate, non-urgent patients who do not require direct emergency department conveyance, yet who cannot be safely left at home alone. Evidence surrounding the safety, effectiveness and efficiency of alternate care routes is not well known. Methods This scoping review sought to identify all studies that examined alternate routes of care for the non-urgent “intermediate” patient, as triaged on scene. Search terms for the sample (ambulances, paramedics, etc.) and intervention (e.g. referrals, alternate care route, non-conveyance) were combined. Articles were systematically searched using four databases and grey literature sources (February 2020). Independent researchers screened title-abstract and full text stages. Results Of 16,037 records, 41 examined alternate routes of care after triage by the on-scene paramedic. Eighteen articles considered quantitative patient data, 12 studies provided qualitative perspectives while 11 were consensus or opinion-based articles. The benefits of alternative schemes are well-recognised by patients, paramedics and stakeholders and there is supporting evidence for a positive impact on patient-centered care and operational efficiency. Challenges to successful use of schemes included: patient safety resulting from incorrect triage decisions, inadequate training, lack of formal partnerships between ambulance and supporting services, and insufficient evidence to support safe implementation or continued use. Studies often inaccurately defined success using proxies for patient safety (e.g. decision comparisons, rates of secondary contact). Finally, patients expressed willingness for such schemes but their preference must be better understood. Conclusions This broad summary offers initial support for alternate routes of care for intermediate, non-urgent patients. Even so, most studies lacked methodologically rigorous evidence and failed to evaluate safe patient outcomes. Some remedies appear to be available such as formal triage pathways, targeted training and organisational support, however there is an urgent need for more research and dissemination in this area.
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11
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van Vuuren J, Thomas B, Agarwal G, MacDermott S, Kinsman L, O'Meara P, Spelten E. Reshaping healthcare delivery for elderly patients: the role of community paramedicine; a systematic review. BMC Health Serv Res 2021; 21:29. [PMID: 33407406 PMCID: PMC7789625 DOI: 10.1186/s12913-020-06037-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 12/21/2020] [Indexed: 12/19/2022] Open
Abstract
Background Healthcare systems are overloaded and changing. In response to growing demands on the healthcare systems, new models of healthcare delivery are emerging. Community paramedicine is a novel approach in which paramedics use their knowledge and skills beyond emergency health response to contribute to preventative and rehabilitative health. In our systematic review, we aimed to identify evidence of the community paramedicine role in care delivery for elderly patients, with an additional focus on palliative care, and the possible impact of this role on the wider healthcare system. Methods A systematic review of peer-reviewed literature from MEDLINE, Embase, CINAHL, and Web of Sciences was undertaken to identify relevant full-text articles in English published until October 3, 2019. Additional inclusion criteria were studies focussing on extended care paramedics or community paramedics caring for elderly patients. Case studies were excluded. All papers were screened by at least two authors and underwent a quality assessment, using the Joanna Briggs Institute appraisal checklists for cross sectional, qualitative, cohort, and randomised controlled trial studies to assess the methodological quality of the articles. A process of narrative synthesis was used to summarise the data. Results Ten studies, across 13 articles, provided clear evidence that Community Paramedic programs had a positive impact on the health of patients and on the wider healthcare system. The role of a Community Paramedic was often a combination of four aspects: assessment, referral, education and communication. Limited evidence was available on the involvement of Community Paramedics in palliative and end-of-life care and in care delivery in residential aged care facilities. Observed challenges were a lack of additional training, and the need for proper integration and understanding of their role in the healthcare system. Conclusions The use of community paramedics in care delivery could be beneficial to both patients’ health and the wider healthcare system. They already play a promising role in improving the care of our elderly population. With consistent adherence to the training curriculum and effective integration within the wider healthcare system, community paramedics have the potential to take on specialised roles in residential aged care facilities and palliative and end-of-life care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-06037-0.
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Affiliation(s)
- Julia van Vuuren
- Department of Community Health, Rural Health School, La Trobe University, Melbourne, Australia.
| | - Brodie Thomas
- Department of Community Health, Rural Health School, La Trobe University, Melbourne, Australia
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, Hamilton, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Sean MacDermott
- Department of Community Health, Rural Health School, La Trobe University, Melbourne, Australia
| | - Leigh Kinsman
- University of Newcastle and Mid-North Coast Local Health District, Port Macquarie Base Hospital, Port Macquarie, Australia
| | - Peter O'Meara
- Department of Paramedicine, Monash University, Peninsula Campus, Melbourne, Australia
| | - Evelien Spelten
- Department of Community Health, Rural Health School, La Trobe University, Melbourne, Australia
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12
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Myall M, Rowsell A, Lund S, Turnbull J, Arber M, Crouch R, Pocock H, Deakin C, Richardson A. Death and dying in prehospital care: what are the experiences and issues for prehospital practitioners, families and bystanders? A scoping review. BMJ Open 2020; 10:e036925. [PMID: 32948555 PMCID: PMC7511644 DOI: 10.1136/bmjopen-2020-036925] [Citation(s) in RCA: 2] [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: 12/29/2022] Open
Abstract
OBJECTIVE To identify the factors that shape and characterise experiences of prehospital practitioners (PHPs), families and bystanders in the context of death and dying outside of the hospital environment where PHPs respond. DESIGN A scoping review using Arksey and O'Malley's five-stage framework. Papers were analysed using thematic analysis. DATA SOURCES MEDLINE; Embase; CINAHL; Scopus; Social Sciences Citation Index (Web of Science), ProQuest Dissertations & Theses A&I (Proquest), Health Technology Assessment database; PsycINFO; Grey Literature Report and PapersFirst were searched from January 2000 to May 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Qualitative and mixed methods studies reporting the experiences of PHPs, families and bystanders of death and dying in prehospital settings as a result of natural causes, trauma, suicide and homicide, >18 years of age, in Europe, USA, Canada, Australia and New Zealand. RESULTS Searches identified 15 352 papers of which 51 met the inclusion criteria. The review found substantial evidence of PHP experiences, except call handlers, and papers reporting family and bystander experiences were limited. PHP work was varied and complex, while confident in clinical work, they felt less equipped to deal with the emotion work, especially with an increasing role in palliative and end-of-life care. Families and bystanders reported generally positive experiences but their support needs were rarely explored. CONCLUSIONS To the best of our knowledge this is the first review that explores the experiences of PHPs, families and bystanders. An important outcome is identifying current gaps in knowledge where further empirical research is needed. The paucity of evidence suggested by this review on call handlers, families and bystanders presents opportunities to investigate their experiences in greater depth. Further research to address the current knowledge gaps will be important to inform future policy and practice.
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Affiliation(s)
- Michelle Myall
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Alison Rowsell
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Susi Lund
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Joanne Turnbull
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Mick Arber
- York Health Economics Consortium, University of York, York, North Yorkshire, UK
| | - Robert Crouch
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Helen Pocock
- South Central Ambulance Service NHS Foundation Trust Southern Headquarters, Otterbourne, Hampshire, UK
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, West Midlands, UK
| | - Charles Deakin
- South Central Ambulance Service NHS Foundation Trust Southern Headquarters, Otterbourne, Hampshire, UK
- NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton, Southampton, Hampshire, UK
| | - Alison Richardson
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Kaasalainen S, Sussman T, Thompson G, McCleary L, Hunter PV, Venturato L, Wickson-Griffiths A, Ploeg J, Parker D, Sinclair S, Dal Bello-Haas V, Earl M, You JJ. A pilot evaluation of the Strengthening a Palliative Approach in Long-Term Care (SPA-LTC) program. BMC Palliat Care 2020; 19:107. [PMID: 32660621 PMCID: PMC7358198 DOI: 10.1186/s12904-020-00599-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 06/19/2020] [Indexed: 12/02/2022] Open
Abstract
Background Despite increased annual mortality in long-term care (LTC) homes, research has shown that care of dying residents and their families is currently suboptimal in these settings. The purpose of this study was to evaluate resident and family outcomes associated with the Strengthening a Palliative Approach in LTC (SPA-LTC) program, developed to help encourage meaningful end of life discussions and planning. Methods The study employs a mixed method design in four LTC homes across Southern Ontario. Data were collected from residents and families of the LTC homes through chart reviews, interviews, and focus groups. Interviews with family who attended a Palliative Care Conference included both closed-ended and open-ended questions. Results In total, 39 residents/families agreed to participate in the study. Positive intervention outcomes included a reduction in the proportion of emergency department use at end of life and hospital deaths for those participating in SPA-LTC, improved support for families, and increased family involvement in the care of residents. For families who attended a Palliative Care Conference, both quantitative and qualitative findings revealed that families benefited from attending them. Residents stated that they appreciated learning about a palliative approach to care and being informed about their current status. Conclusions The benefits of SPA-LTC for residents and families justify its continued use within LTC. Study results also suggest that certain enhancements of the program could further promote future integration of best practices within a palliative approach to care within the LTC context. However, the generalizability of these results across LTC homes in different regions and countries is limited given the small sample size.
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Affiliation(s)
- Sharon Kaasalainen
- School of Nursing, McMaster University, 1280 Main Street West, HSC 3N25F, Hamilton, ON, L8S 4K1, Canada.
| | - Tamara Sussman
- School of Social Work, McGill University, 3506 University St., Montreal, QC, Canada
| | - Genevieve Thompson
- College of Nursing, Max Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB, Canada
| | - Lynn McCleary
- Faculty of Applied Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2N 3A1, Canada
| | - Paulette V Hunter
- St. Thomas More College, University of Saskatchewan, 1437 College Drive, Saskatoon, SK, Canada
| | - Lorraine Venturato
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada
| | | | - Jenny Ploeg
- School of Nursing, McMaster University, 1280 Main Street West, HSC 3N25F, Hamilton, ON, L8S 4K1, Canada
| | - Deborah Parker
- Faculty of Health, University of Technology Sydney, 235 Jones St, Ultimo, Australia
| | - Shane Sinclair
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada
| | - Vanina Dal Bello-Haas
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, IAHS 403E, Hamilton, ON, Canada
| | - Marie Earl
- School of Physiotherapy, Dalhousie University, 5869 University Avenue, Halifax, NS, Canada
| | - John J You
- Division of General Internal and Hospitalist Medicine, Credit Valley Hospital, Trillium Health Partners, 2200 Eglinton Ave W, Mississauga, ON, Canada
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Nemiroff L, Marshall EG, Jensen JL, Clarke B, Andrew MK. Adherence to “No Transfer to Hospital” Advance Directives Among Nursing Home Residents. J Am Med Dir Assoc 2019; 20:1373-1381. [DOI: 10.1016/j.jamda.2019.03.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 03/28/2019] [Accepted: 03/29/2019] [Indexed: 10/26/2022]
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Martin-Misener R, Wong ST, Johnston S, Blackman S, Scott C, Hogg W, Burge F, Grool AM, Campbell JL, Wuite S. Regional variation in primary care improvement strategies and policy: case studies that consider qualitative contextual data for performance measurement in three Canadian provinces. BMJ Open 2019; 9:e029622. [PMID: 31628125 PMCID: PMC6803109 DOI: 10.1136/bmjopen-2019-029622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 08/26/2019] [Accepted: 09/13/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To explore regional primary care improvement strategies that are potentially determinants of primary care performance. DESIGN Multiple comparative embedded case study. SETTING Three regions in Canada: Fraser East, British Columbia; Eastern Ontario Health Unit, Ontario; Central Zone, Nova Scotia. DATA SOURCES (1) In-depth interviews with purposively selected key informants (eg, primary care decision-makers, physician leads, regulatory agencies) and focus groups with patients and clinicians (n=68 participants) and (2) published and grey literature (n=205 documents). OUTCOME MEASURES Variations in spread and uptake of primary care improvement strategies across the three study regions. NVivo (V.11) was used to manage data and perform content analysis to identify categories within and across cases. The coding structure was developed by researchers through iterative collaboration, using inductive and deductive processes. RESULTS Six overarching primary care improvement strategies, differing in focus and spread, were implemented across the three study regions: interprofessional team-based approaches, provider skill mix expansion, physician groups and networks, information systems, remuneration and performance measurement and reporting infrastructure. CONCLUSION The addition of information on regional improvement strategies to primary care performance reports could add important contextual insights into primary care performance results. This could help identify possible drivers of reported performance outcomes and levers for change in practice, regional and system-level settings.
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Affiliation(s)
| | - Sabrina T Wong
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sharon Johnston
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Catherine Scott
- PolicyWise for Children & Families, Calgary, Alberta, Canada
| | - William Hogg
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Montfort Hospital Research Institute, Ottawa, Ontario, Canada
| | - Fred Burge
- Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anne M Grool
- Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - John L Campbell
- Peninsula Medical School, University of Exeter, Exeter, United Kingdom
| | - Sara Wuite
- Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Waldrop DP, McGinley JM, Clemency B. Mediating Systems of Care: Emergency Calls to Long-Term Care Facilities at Life's End. J Palliat Med 2018; 21:987-991. [DOI: 10.1089/jpm.2017.0332] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Brian Clemency
- Emergency Medicine Department, Erie County Medical Center, Buffalo, New York
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Correlation of age and rurality with low-urgency use of emergency medical services (LUEMS): A geographic analysis. CAN J EMERG MED 2017; 20:874-881. [PMID: 28774350 DOI: 10.1017/cem.2017.364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Studies suggest that addressing the needs of the older population in rural areas may substantially reduce their low-urgency use of emergency medical services (LUEMS). It may ultimately also help improve the efficiency in our health system. There is, however, a dearth of evidence substantiating geographic patterns in LUEMS by different age cohorts. This exploratory study was aimed to clarify the understanding of emergency medical services (EMS) use in Nova Scotia through a geographic analysis. METHODS Records with Canadian Triage and Acuity Scale of 4 and 5 were considered as LUEMS. We assessed the distribution of LUEMS incidence rates (proportion of LUEMS out of all EMS uses) by age and rurality, using descriptive statistics and Geographic Information Systems mapping. RESULTS Nearly half of all EMS transports were individuals of 65+ years of age; 35% of those were LUEMS. The rates increased along with the level of rurality, and the older cohort had the highest incidence rates in non-metro communities. High rates were seen primarily in some rural communities farthest away from the capital/tertiary care centre. CONCLUSION High LUEMS incidence rates are rural phenomena but not specific to the older population. However, the absolute number of LUEMS by the older cohort is significant, and elder-specific interventions in rural regions could still lead to effective cost savings. Further investigation of other factors, such as distance to the emergency department, availability of public transportation, and socioeconomic conditions of EMS users, is needed.
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Rosen T, Lien C, Stern ME, Bloemen EM, Mysliwiec R, McCarthy TJ, Clark S, Mulcare MR, Ribaudo DS, Lachs MS, Pillemer K, Flomenbaum NE. Emergency Medical Services Perspectives on Identifying and Reporting Victims of Elder Abuse, Neglect, and Self-Neglect. J Emerg Med 2017; 53:573-582. [PMID: 28712685 DOI: 10.1016/j.jemermed.2017.04.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/28/2017] [Accepted: 04/25/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Emergency Medical Services (EMS) providers, who perform initial assessments of ill and injured patients, often in a patient's home, are uniquely positioned to identify potential victims of elder abuse, neglect, or self-neglect. Despite this, few organized programs exist to ensure that EMS concerns are communicated to or further investigated by other health care providers, social workers, or the authorities. OBJECTIVE To explore attitudes and self-reported practices of EMS providers surrounding identification and reporting of elder mistreatment. METHODS Five semi-structured focus groups with 27 EMS providers. RESULTS Participants reported believing they frequently encountered and were able to identify potential elder mistreatment victims. Many reported infrequently discussing their concerns with other health care providers or social workers and not reporting them to the authorities due to barriers: 1) lack of EMS protocols or training specific to vulnerable elders; 2) challenges in communication with emergency department providers, including social workers, who are often unavailable or not receptive; 3) time limitations; and 4) lack of follow-up when EMS providers do report concerns. Many participants reported interest in adopting protocols to assist in elder protection. Additional strategies included photographically documenting the home environment, additional training, improved direct communication with social workers, a dedicated location on existing forms or new form to document concerns, a reporting hotline, a system to provide feedback to EMS, and community paramedicine. CONCLUSIONS EMS providers frequently identify potential victims of elder abuse, neglect, and self-neglect, but significant barriers to reporting exist. Strategies to empower EMS providers and improve reporting were identified.
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Affiliation(s)
- Tony Rosen
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York
| | - Cynthia Lien
- Division of Geriatric and Palliative Medicine, Weill Cornell Medical College, New York, New York
| | - Michael E Stern
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York
| | | | - Regina Mysliwiec
- Department of Emergency Medicine, Oregon Health Sciences University, Astoria, Oregon
| | - Thomas J McCarthy
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York
| | - Sunday Clark
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York
| | - Mary R Mulcare
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York
| | - Daniel S Ribaudo
- Emergency Medical Services, New York-Presbyterian Hospital, New York, New York
| | - Mark S Lachs
- Division of Geriatric and Palliative Medicine, Weill Cornell Medical College, New York, New York
| | - Karl Pillemer
- Department of Human Development, Cornell University, Ithaca, New York
| | - Neal E Flomenbaum
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York; Emergency Medical Services, New York-Presbyterian Hospital, New York, New York
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Flynn D, Francis R, Robalino S, Lally J, Snooks H, Rodgers H, McClelland G, Ford GA, Price C. A review of enhanced paramedic roles during and after hospital handover of stroke, myocardial infarction and trauma patients. BMC Emerg Med 2017; 17:5. [PMID: 28228127 PMCID: PMC5322648 DOI: 10.1186/s12873-017-0118-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 02/17/2017] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Ambulance paramedics play a critical role expediting patient access to emergency treatments. Standardised handover communication frameworks have led to improvements in accuracy and speed of information transfer but their impact upon time-critical scenarios is unclear. Patient outcomes might be improved by paramedics staying for a limited time after handover to assist with shared patient care. We aimed to categorize and synthesise data from studies describing development/extension of the ambulance-based paramedic role during and after handover for time-critical conditions (trauma, stroke and myocardial infarction). METHODS We conducted an electronic search of published literature (Jan 1990 to Sep 2016) by applying a structured strategy to eight bibliographic databases. Two reviewers independently assessed eligible studies of paramedics, emergency medical (or ambulance) technicians that reported on the development, evaluation or implementation of (i) generic or specific structured handovers applied to trauma, stroke or myocardial infarction (MI) patients; or (ii) paramedic-initiated care processes at handover or post-handover clinical activity directly related to patient care in secondary care for trauma, stroke and MI. Eligible studies had to report changes in health outcomes. RESULTS We did not identify any studies that evaluated the health impact of an emergency ambulance paramedic intervention following arrival at hospital. A narrative review was undertaken of 36 studies shortlisted at the full text stage which reported data relevant to time-critical clinical scenarios on structured handover tools/protocols; protocols/enhanced paramedic skills to improve handover; or protocols/enhanced paramedic skills leading to a change in in-hospital transfer location. These studies reported that (i) enhanced paramedic skills (diagnosis, clinical decision making and administration of treatment) might supplement handover information; (ii) structured handover tools and feedback on handover performance can impact positively on paramedic behaviour during clinical communication; and (iii) additional roles of paramedics after arrival at hospital was limited to 'direct transportation' of patients to imaging/specialist care facilities. CONCLUSIONS There is insufficient published evidence to make a recommendation regarding condition-specific handovers or extending the ambulance paramedic role across the secondary/tertiary care threshold to improve health outcomes. However, previous studies have reported non-clinical outcomes which suggest that structured handovers and enhanced paramedic actions after hospital arrival might be beneficial for time-critical conditions and further investigation is required.
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Affiliation(s)
- Darren Flynn
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX United Kingdom
| | - Richard Francis
- Institute of Neuroscience (Stroke Research Group), Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Shannon Robalino
- Research Design Service - North East, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Joanne Lally
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX United Kingdom
| | - Helen Snooks
- College of Medicine, Swansea University, Wales, United Kingdom
| | - Helen Rodgers
- Institute of Neuroscience (Stroke Research Group), Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Graham McClelland
- North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Gary A. Ford
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Christopher Price
- Institute of Neuroscience (Stroke Research Group), Newcastle University, Newcastle upon Tyne, United Kingdom
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20
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Tavares W, Bowles R, Donelon B. Informing a Canadian paramedic profile: framing concepts, roles and crosscutting themes. BMC Health Serv Res 2016; 16:477. [PMID: 27605119 PMCID: PMC5015210 DOI: 10.1186/s12913-016-1739-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 09/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Paramedicine is a rapidly evolving health profession with increasing responsibilities and contributions to healthcare. This rapid growth has left the profession with unclear professional and clinical boundaries. Existing defining frameworks may no longer align with the practice of paramedicine or expectations of the public. The purpose of this study was to explore the roles paramedics in Canada are to embody and that align with or support the rapid and ongoing evolution of the profession. METHODS We used a concurrent mixed methods study design involving a focused discourse analysis (i.e., analysis of language used to describe paramedics and paramedicine) of peer reviewed and grey literature (Phase 1) and in-depth one-on-one semi-structured interviews with key informants in Canadian paramedicine (Phase 2). Data from both methods were analyzed simultaneously throughout and after being merged using inductive thematic analysis. RESULTS Saturation was reached after 99 national and international grey and peer reviewed publications and 20 in depth interviews with stakeholders representing six provinces, seven different service/agency types, 11 operational roles and seven provider roles. After merging both data sets three framing concepts, six roles and four crosscutting themes emerged that may be significant to both present-day practice and aspirational. Framing concepts, which provide context, include variable contexts or practice, embedded relationships and a health and social continuum. Roles include clinician, health and social advocate, team member, educator, professional and reflective practitioner. Crosscutting themes including patient safety, adaptability, compassion and communication appear to exist in all roles. CONCLUSIONS The paramedic profession is experiencing a shift that appears to deviate or at least place a tension on traditional views or models of practice. Underlying and evolving notions of practice are resulting in intended or actual clinical and professional boundaries that may require the profession to re-think how it is defined and/or shaped. Until these framing concepts, roles and crosscutting themes are fully understood, tested and operationalized, tensions between guiding frameworks and actual or intended practice may persist.
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Affiliation(s)
- Walter Tavares
- Centennial College, School of Community and Health Studies, 941 Progress Ave. Station A, P.O. Box 631, M1K 5E9 Toronto, ON Canada
- York Region Paramedic Services, 80 Bales Dr. E. R.R.#1, L0G 1V0 East Sharon, ON Canada
- Ornge Transport Medicine, 5310, Mississauga, L4W 5H8 ON Canada
- Paramedic Association of Canada, 201-4 Florence St., K2P 0W7 Ottawa, ON Canada
- McMaster University, 1200 Main St., L8N 3Z5 Hamilton, ON Canada
| | - Ron Bowles
- Justice Institute of British Columbia, 715 McBride Blvd, V3L 5T4 New Westminster, BC Canada
- Society for Prehospital Educators of Canada, 101-265 Carleton Dr., T8N 4J9 St. Albert, AB Canada
| | - Becky Donelon
- Alberta College of Paramedics, 2755 Broadmoor Blvd., T8H 2W7 Sherwood Park, AB Canada
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Applying hospital evidence to paramedicine: issues of indirectness, validity and knowledge translation. CAN J EMERG MED 2016; 17:281-5. [PMID: 26034914 DOI: 10.1017/cem.2015.65] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The practice of emergency medicine (EM) has been intertwined with emergency medical services (EMS) for more than 40 years. In this commentary, we explore the practice of translating hospital based evidence into the prehospital setting. We will challenge both EMS and EM dogma-bringing hospital care to patients in the field is not always better. In providing examples of therapies championed in hospitals that have failed to translate into the field, we will discuss the unique prehospital environment, and why evidence from the hospital setting cannot necessarily be translated to the prehospital field. Paramedicine is maturing so that the capability now exists to conduct practice-specific research that can inform best practices. Before translation from the hospital environment is implemented, evidence must be evaluated by people with expertise in three domains: critical appraisal, EM, and EMS. Scientific evidence should be assessed for: quality and bias; directness, generalizability, and validity to the EMS population; effect size and anticipated benefit from prehospital application; feasibility (including economic evaluation, human resource availability in the mobile environment); and patient and provider safety.
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Turner J, Coster J, Chambers D, Cantrell A, Phung VH, Knowles E, Bradbury D, Goyder E. What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03430] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundIn 2013 NHS England set out its strategy for the development of an emergency and urgent care system that is more responsive to patients’ needs, improves outcomes and delivers clinically excellent and safe care. Knowledge about the current evidence base on models for provision of safe and effective urgent care, and the gaps in evidence that need to be addressed, can support this process.ObjectiveThe purpose of the evidence synthesis is to assess the nature and quality of the existing evidence base on delivery of emergency and urgent care services and identify gaps that require further primary research or evidence synthesis.Data sourcesMEDLINE, EMBASE, The Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Web of Science.MethodsWe have conducted a rapid, framework-based, evidence synthesis approach. Five separate reviews linked to themes in the NHS England review were conducted. One general and five theme-specific database searches were conducted for the years 1995–2014. Relevant systematic reviews and additional primary research papers were included and narrative assessment of evidence quality was conducted for each review.ResultsThe review was completed in 6 months. In total, 45 systematic reviews and 102 primary research studies have been included across all five reviews. The key findings for each review are as follows: (1) demand – there is little empirical evidence to explain increases in demand for urgent care; (2) telephone triage – overall, these services provide appropriate and safe decision-making with high patient satisfaction, but the required clinical skill mix and effectiveness in a system is unclear; (3) extended paramedic roles have been implemented in various health settings and appear to be successful at reducing the number of transports to hospital, making safe decisions about the need for transport and delivering acceptable, cost-effective care out of hospital; (4) emergency department (ED) – the evidence on co-location of general practitioner services with EDs indicates that there is potential to improve care. The attempt to summarise the evidence about wider ED operations proved to be too complex and further focused reviews are needed; and (5) there is no empirical evidence to support the design and development of urgent care networks.LimitationsAlthough there is a large body of evidence on relevant interventions, much of it is weak, with only very small numbers of randomised controlled trials identified. Evidence is dominated by single-site studies, many of which were uncontrolled.ConclusionsThe evidence gaps of most relevance to the delivery of services are (1) a requirement for more detailed understanding and mapping of the characteristics of demand to inform service planning; (2) assessment of the current state of urgent care network development and evaluation of the effectiveness of different models; and (3) expanding the current evidence base on existing interventions that are viewed as central to delivery of the NHS England plan by assessing the implications of increasing interventions at scale and measuring costs and system impact. It would be prudent to develop a national picture of existing pilot projects or interventions in development to support decisions about research commissioning.FundingThe National Institute for Health Research Health Services and Delivery Research Programme.
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Affiliation(s)
- Janette Turner
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Joanne Coster
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Duncan Chambers
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Viet-Hai Phung
- College of Social Science, University of Lincoln, Lincoln, UK
| | - Emma Knowles
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Daniel Bradbury
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Goyder
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Jensen JL, Marshall EG, Carter AJE, Boudreau M, Burge F, Travers AH. Impact of a Novel Collaborative Long-Term Care -EMS Model: A Before-and-After Cohort Analysis of an Extended Care Paramedic Program. PREHOSP EMERG CARE 2015; 20:111-6. [PMID: 26727341 DOI: 10.3109/10903127.2015.1051678] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
To compare system and clinical outcomes before and after an extended care paramedic (ECP) program was implemented to better address the emergency needs of long-term care (LTC) residents. Data were collected from emergency medical services (EMS), hospital, and ten LTC facility charts for two five-month time periods, before and after ECP implementation. Outcomes include: number of EMS patients transported to emergency department (ED) and several clinical, safety, and system secondary outcomes. Statistics included descriptive, chi-squared, t-tests, and ANOVA; α = <0.05. 413 cases were included (before: n = 136, 33%; after n = 277, 67%). Median patient age was 85 years (IQR 77-91 years) and 292/413 (70.7%) were female. The number of transports to ED before implementation was 129/136 (94.9%), with 147/224 (65.6%) after, p < 0.001. In the after period, fewer patients seen by ECP were transported: 58/128 (45.3%) vs. 89/96 (92.7%) of those not seen by ECP, p < 0.001. Hospital admissions were similar between phases: 39/120 (32.5%) vs. 56/213 (29.4%), p = NS, but in the after phase, fewer ECP patients were admitted vs. non-ECP: 21/125 (16.8%) vs. 35/88 (39.8%), p < 0.001. Mean EMS call time (dispatch to arrive ED or clear scene) was shorter before than after: 25 minutes vs. 57 minutes, p < 0.001. In the after period, calls with ECP were longer than without ECP: 1 hour, 35 minutes vs. 30 minutes, p < 0.001. The mean patient ED length-of-stay was similar before and after: 7 hours, 29 minutes compared to 8 hours, 11 minutes; p = NS. In the after phase, ED length-of-stay was somewhat shorter with ECPs vs. no ECPs: 7 hours, 5 minutes vs. 9 hours, p = NS. There were zero relapses after no-transport in the before phase and three relapses from 77 calls not transported in the after phase (3/77, 3.9%); two involved ECP (2/70, 2.8%). Reductions were observed in the number of LTC patients transported to the ED when the ECP program was introduced, with fewer patients admitted to the hospital. EMS calls take longer with ECP involved. The addition of ECP to the LTC model of care appears to be beneficial and safe, with few relapse calls identified.
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Alternatives to Traditional EMS Dispatch and Transport: A Scoping Review of Reported Outcomes. CAN J EMERG MED 2015; 17:532-50. [DOI: 10.1017/cem.2014.59] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectivesEmergency medical services (EMS) programs, which provide an alternative to traditional EMS dispatch or transport to the emergency department (ED), are becoming widely implemented. This scoping review identified and catalogued all outcomes used to measure such alternative EMS programs.Data SourceBroad systematized bibliographic and grey literature searches were conducted.Study SelectionInclusion criteria were 911 callers/EMS patients, reported on alternatives to traditional EMS dispatch OR traditional EMS transport to the ED, and reported an outcome measure.Data ExtractionThe reports were categorized as either alternative to dispatch or to EMS transport, and outcome measures were categorized and described.Data SynthesisThe bibliographic search retrieved 13,215 records, of which 34 articles met the inclusion criteria, with an additional 10 added from reference list hand-searching (n=44 included). In the grey literature search, 31 websites were identified, from which four met criteria and were retrieved (n=4 included). Fifteen reports (16 studies) described alternatives to EMS dispatch, and 33 reports described alternatives to EMS transport. The most common outcomes reported in the alternatives to EMS dispatch reports were service utilization and decision accuracy. Twenty-four different specific outcomes were reported. The most common outcomes reported in the alternatives to EMS transport reports were service utilization and safety, and 50 different specific outcomes were reported.ConclusionsNumerous outcome measures were identified in reports of alternative EMS programs, which were catalogued and described. Researchers and program leaders should achieve consensus on uniform outcome measures, to allow benchmarking and improve comparison across programs.
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