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

• Published in: Journal of the American Geriatrics Society (JAGS) 2023-02, Vol.71 (2), p.484-495
• Main Authors: Foucaud, Amandine, Gilbert, Thomas, Vincent, Adélaïde, Jomard, Nathalie, Comte, Brigitte, Porthault, Sylvie, Comte, Gaële, Theurey, Odile, Gueugniaud, Pierre‐Yves, Bourelly, Laura, Rabilloud, Muriel, Boutitie, Florent, Douplat, Marion, Tassa, Ouazna, Haesebaert, Julie, Termoz, Anne, Schott, Anne‐Marie
• Format: Article
• Language: English
• Subjects: Aged; dispatching physicians; Elder care; emergency department; Emergency medical care; Emergency Medical Services; Emergency Service, Hospital; Family physicians; Geriatricians; Geriatrics; Humans; Medical referrals; older; Patients; Physicians; Referral and Consultation; Statistics; telephone triage
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.18101

Background Emergency Departments (ED) have seen an increasing number of older patients who are mostly referred following a call to the Emergency Medical Services (EMS). Long waiting times in settings, which are not designed to meet older patients' needs, may increase the risk of hospital‐acquired complications. Unnecessary visits should therefore be avoided as much as possible. The objective of the study was to evaluate whether a program to provide geriatric knowledge and tools to the dispatching physicians of the EMS could decrease ED referrals of older patients. Methods Design: Before‐and‐after study with two 6‐month periods before and after intervention. Participants: All calls received by a dispatching physician of the Rhône EMS from 8 am to 6 pm concerning patients aged 75 years or above during the study period. Intervention: A program consisting of training dispatching physicians in the specific care of older patients and the developing, with a multidisciplinary team, of specific tools for dispatching physicians. Outcome: Proportion of ED referrals of patients aged 75 years or above after a call to the EMS. Results A total of 2671 calls to the Rhône EMS were included corresponding to 1307 and 1364 patients in the pre‐and post‐intervention phases, respectively. There was no significant difference in the proportion of referrals to the ED between the pre‐intervention (61.7%) and the post‐intervention (62.8%) phases (p = 0.57). Contact of the patients with their General Practitioner (GP) in the month preceding the call was associated with a 22% reduced probability of being referred to an ED. Conclusions No beneficial effect of the intervention was demonstrated. This strategy of intervention is probably not effective enough in such time‐constraint environment. Other strategies with a specific parallel dispatching of geriatric calls by geriatricians should be tested to avoid these unnecessary ED referrals. Trial registration: ClinicalTrials NCT02712450.