Paramedic-PCP Protocol Can Cut ER Visits for Assisted Living Falls
WEDNESDAY, Dec. 13, 2017 -- A protocol involving collaboration between paramedics and primary care physicians could help prevent transport to the emergency department for residents of assisted living facilities who have fallen, according to a study published online Dec. 12 in the Annals of Internal Medicine.
Jefferson G. Williams, M.D., from Wake County Emergency Medical Services in Raleigh, N.C., and colleagues conducted a prospective cohort study to examine whether unnecessary transport can be avoided in a sample of residents in 22 assisted living facilities served by one group of primary care physicians. Paramedics providing emergency medical services followed a protocol involving a telephone consult with a physician. A total of 953 eligible residents consented to participate in the study; 359 had 840 falls in 43 months.
The researchers found that the protocol recommended non-transport for 553 of the 840 falls. Eleven of the patients recommended for non-transport had a time-sensitive condition; at least seven received appropriate care, with four requesting and receiving transport despite the protocol recommendation and three having successful management of minor injuries on site. Fractures were diagnosed by outpatient radiology in three additional patients. The final patient died 60 hours after the fall. At least 99.3 percent of the 553 patients with a recommendation for non-transport received appropriate care.
"Shared decision making between paramedics and primary care physicians can prevent transport to the emergency department for many residents of assisted living facilities who fall," the authors write.
One author received fees from Wake County Emergency Medical Services during conduct of the study; a second author disclosed financial ties to Envision Healthcare.
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Posted: December 2017