Evidence-based paramedic models of care to reduce unnecessary emergency department attendance – feasibility and safety

Finn, Judith C., Fatovich, Daniel M., Arendts, Glenn, Mountain, David, Tohira, Hideo, Williams, Teresa A., Sprivulis, Peter, Celenza, Antonia, Ahern, Tony, Bremner, Alexandra P., Cameron, Peter, Borland, Meredith L., Rogers, Ian R. and Jacobs, Ian G. (2013) Evidence-based paramedic models of care to reduce unnecessary emergency department attendance – feasibility and safety. BMC Emergency Medicine, 13 1: 1-6. doi:10.1186/1471-227X-13-13

Author Finn, Judith C.
Fatovich, Daniel M.
Arendts, Glenn
Mountain, David
Tohira, Hideo
Williams, Teresa A.
Sprivulis, Peter
Celenza, Antonia
Ahern, Tony
Bremner, Alexandra P.
Cameron, Peter
Borland, Meredith L.
Rogers, Ian R.
Jacobs, Ian G.
Title Evidence-based paramedic models of care to reduce unnecessary emergency department attendance – feasibility and safety
Journal name BMC Emergency Medicine   Check publisher's open access policy
ISSN 1471-227X
Publication date 2013-07-15
Sub-type Article (original research)
DOI 10.1186/1471-227X-13-13
Open Access Status DOI
Volume 13
Issue 1
Start page 1
End page 6
Place of publication London, United Kingdom
Publisher BioMed Central
Language eng
Formatted abstract
Background: As demand for Emergency Department (ED) services continues to exceed increases explained by population growth, strategies to reduce ED presentations are being explored. The concept of ambulance paramedics providing an alternative model of care to the current default ‘see and transport to ED’ has intuitive appeal and has been implemented in several locations around the world. The premise is that for certain non-critically ill patients, the Extended Care Paramedic (ECP) can either ‘see and treat’ or ‘see and refer’ to another primary or community care practitioner, rather than transport to hospital. However, there has been little rigorous investigation of which types of patients can be safely identified and managed in the community, or the impact of ECPs on ED attendance.

Methods/Design: St John Ambulance Western Australia paramedics will indicate on the electronic patient care record (e-PCR) of patients attended in the Perth metropolitan area if they consider them to be suitable to be managed in the community. ‘Follow-up’ will examine these patients using ED data to determine the patient’s disposition from the ED. A clinical panel will then develop a protocol to identify those patients who can be safely managed in the community. Paramedics will then assess patients against the derived ECP protocols and identify those deemed suitable to ‘see and treat’ or ‘see and refer’. The ED disposition (and other clinical outcomes) of these ‘ECP protocol identified’ patients will enable us to assess whether it would have been appropriate to manage these patients in the community. We will also ‘track’ re-presentations to EDs within seven days of the initial presentation. This is a ‘virtual experiment’ with no direct involvement of patients or changes in clinical practice. A systems modelling approach will be used to assess the likely impact on ED crowding.

Discussion: To date the efficacy, cost-effectiveness and safety of alternative community-based models of emergency care have not been rigorously investigated. This study will inform the development of ECP protocols through the identification of types of patient presentation that can be considered both safe and appropriate for paramedics to manage in the community. 
Keyword Pre-hospital
Extended care paramedics
Emergency department demand
Community care
Patient safety
Economic evaluation
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ
Additional Notes Article number 13.

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Nursing, Midwifery and Social Work Publications
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Citation counts: Scopus Citation Count Cited 4 times in Scopus Article | Citations
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Created: Tue, 15 Jul 2014, 08:49:41 EST by Vicki Percival on behalf of School of Nursing, Midwifery and Social Work