Building Capacity in Healthcare by Re-examining Clinical Services in Paramedicine
Creators: name: Tavares, Walter
name: Drennan, Ian
name: Diepen, Kelly Van
name: Abanil, Michael
name: Kedzierski, Natalie
name: Spearen, Chris
name: Norm Barrette
name: Mercuri, Mathew
Publisher: name: Taylor & Francis
Year: 2017
Subjects: subject: Medicine
subject: Biotechnology
subject: 69999 Biological Sciences not elsewhere classified
subject: FOS: Biological sciences
subject: FOS: Biological sciences
subject: 80699 Information Systems not elsewhere classified
subject: FOS: Computer and information sciences
subject: FOS: Computer and information sciences
subject: Cancer
subject: 111714 Mental Health
subject: FOS: Health sciences
subject: FOS: Health sciences

description: <b>Objectives</b>: Emergency departments (ED) continue to be overburdened, leading to crowding and elevated risk of negative clinical outcomes. Extending clinical services to paramedics may support efforts to improve ED burdens by promoting health care access and capacity during times of patient crisis. The objective of this study was to identify the clinical course and most responsible diagnosis of patients transported by paramedic services to local EDs to then evaluate impact of various augmented 9-1-1/paramedic clinical service models on the need for additional ED services. <b>Methods</b>: A retrospective cohort and model-simulation based study. We retrieved clinical data from hospital records for a random selection of 3,000 patients who engaged 9-1-1/paramedic services and were transported to a regional ED to identify their clinical course (interventions, diagnostics) disposition and most responsible admitting/discharge diagnosis. We used this data to establish, simulate and test numerous paramedic service models on the need for ED services. <b>Results</b>: A random selection of 3,000 patients was reviewed across 3 hospitals. The majority were female (57.2%) with a mean age of 65 (SD = 21.3). The majority (<i>n</i> = 1954; 65.1%) were discharged directly from ED of which 3.6% (<i>n</i> = 108) received no intervention or diagnostic, 20.4% (<i>n</i> = 611) received only a diagnostic, 4.8% (<i>n</i> = 143) received only an intervention and 36.4% (<i>n</i> = 1092) received both an intervention and diagnostic. The proportion of nonadmitted patients rose to 82.2% and 77.2% when considering lower priority patients and age greater than 65, respectively. Patient types were identified based on frequency and association with discharge directly from ED. Twelve simulated augmented paramedic clinical service models are reported with estimated gains in the number of patients who may no longer require ED services ranging from 7.5% (<i>n</i> = 146) to 35.4% (<i>n</i> = 691). <b>Conclusions</b>: This study suggests a reduction in need for ED services may be achieved through innovative models of paramedic services at the time of crisis. Identifying and confirming patient types/events to target and clinical services to include in the model requires ongoing investigation. Future research will be needed to evaluate the accuracy and impact of the models presented. <b>Keywords</b>: Paramedic; EMS; Community Paramedicine; Healthcare Service Delivery; ED Crowding; primary care