Decreasing Emergency Room Utilization in High Risk Geriatric Patients

Abstract

Background: The Acute Life Interventions Goals & Needs Program (ALIGN) at the Mount Sinai Hospital in New York City aims to work closely with high risk geriatric patients for short term intensive management of acute medical and social issues. Quantitative measures for determining success of the program is comparing emergency room visits and hospitalizations prior to and after enrollment with ALIGN. The Community Paramedicine service allows a paramedic, the ALIGN provider, and an emergency room physician to assess and triage patients in their home via video conference thereby avoiding ED visits for non-urgent services. Method: We reviewed the utilization of the Community Paramedicine service (from July 2017-February 2020) and its impact on ALIGN’s efforts to reduce unnecessary ED visits and hospitalizations. Results: 36 patients were evaluated with the Community Paramedicine service (from July 2017-February 2020). 19 or 52.8% avoided an ED visit and 17 or 47.2% were transported to the ED. 12 or 70.6% were admitted to the hospital of those that were transported to the ED initially. Top reasons for transport to ED included generalized weakness, acute mental status change (AMS), and shortness of breath (SOB). Conclusions: A Community Paramedicine program utilized by a high risk geriatrics team like ALIGN is effective in reducing ED visits and hospitalizations for the elderly population who incur greater expenses to the health care system and traditionally have poorer health outcomes.

“They’re very passionate about making sure that women stay healthy”: a qualitative examination of women’s experiences participating in a community paramedicine program

“…Community paramedicine programs have a long history and are becoming increasingly common, but their value and effectiveness in the United States have not been extensively studied [ 13 – 16 ]. The small body of available literature on community paramedicine, which has primarily focused on older adult health and frequent EMS users, demonstrates high patient satisfaction levels, reductions in ER visits and hospital readmission, and reductions in costs of care [ 13 , 31 , 32 ]. Canada has, by far, the most well-documented community paramedicine programs and the most rigorous evidence base [ 10 , 11 , 33 – 37 ].…”