Effect of a Mobile Integrated Hospice Healthcare Program on Emergency Medical Services Transport to the Emergency Department

Abstract

Objective: To evaluate the effect of a Mobile Integrated Hospice Healthcare (MIHH) program including hospice education and expansion of paramedic scope of practice to use hospice medication kits. Primary outcome was the effect on hospice patient transport to the Emergency Department. Secondary outcomes included reasons for patient transport and review of MIHH kit utilization. Methods: In 2015, the project was implemented in Ventura County, California in collaboration with county emergency medical services (EMS) agency, first response/ transport organizations, and hospice programs. Paramedic supervisors received 30 hours of hospice training focusing on palliative care, grief and crisis counseling. When 9-1-1 was called for a patient, EMS first responders arrived on scene, determined a patient was enrolled in hospice and then contacted trained MIHH. Results: Six months (2/ 2015-7/2015) prior to project implementation the percentage of hospice patients transported to the ED averaged 80.3% (98/122). During the first (8/2015-7/2016), second (8/2016-7/2017) and third year (8/2017-7/2018) after project implementation, the percentage of hospice patients transported to the ED was 36.2% (68/188), 33.2% (63/190) and 24.8% (36/145) respectively. A total of 523 hospice patients were cared for by MIHH during this three-year interval. Of those hospice patients transported, the most common reason for transport was fall/trauma. The MIHH hospice kit was only used once in the field. Odds ratio for hospice transportation to the ED before and after project implementation was 0.125 (95% Confidence Interval: 0.077 to 0.201; p < 0.0001). This represents an absolute reduction risk of 46.6% (95% Confidence Interval: 38.53% to 54.72%). Conclusion: MIHH decreased the transportation of hospice patients to the ED. MIHH provided hospice education, provided family grief support and developed treatment plans with hospice nurses. An expanded scope of practice, including a paramedic hospice kit, was not contributory to this decrease.

Emergency medical services and palliative care: a scoping review

“… 6 Such collaborations between palliative and EMS systems, making use of newly developed palliative care guidelines and protocols for EMS providers, were successfully deployed in Canada, 15 Finland 66 and the USA. 34 …”

“…Included studies were performed in the USA (n=16),1 6 26–39 the UK (n=9),7 14 40–46 Germany (n=10),8 47–55 Australia (n=8),2 4 11 56–60 Canada (n=4),15 61–63 France (n=1),5 Switzerland (n=1),13 New Zealand (n=2),64 65 Finland (n=2),66 67 Czech Republic (n=1),68 Brazil (n=1)69 and South Africa (n=1)16 between 2002 and 2022. The majority of studies (96%, n=54) were performed in HICs with only Brazil and South Africa representing LMICs, and most (63%, n=35) were published between 2018 and 2022.…”

“…Methodologically, most studies were quantitative (55%, n=31) while the remainder used a qualitative (27%, n=15) or mixed-methods (18%, n=10) approach. Quantitative studies comprised of surveys (n=12),1 8 30 32 38 41 43 48 49 51 56 58 retrospective cohorts (n=9),5 33 34 40 52 54 55 57 66 literature reviews (n=5),11 46 61 64 68 case series/reports (n=3),6 13 35 a pre-intervention and post-intervention study (n=1)29 and a prospective cohort (n=1) 8. Qualitative studies contained individual interviews (n=12),7 14 16 26–28 31 42 44 47 65 69 focus group interviews (n=2)2 63 and deliberative dialogues (n=1),62 while the mixed-methods studies4 15 36 37 39 45 50 59 60 67 made use of various survey and interview combinations.…”

“…6 Such collaborations between palliative and EMS systems, making use of newly developed palliative care guidelines and protocols for EMS providers, were successfully deployed in Canada, 15 Finland 66 and the USA. 34 Concerning further research, the following areas were recommended: educational interventions, 46 development of EMS palliative care protocols, 16 defining the role of EMS in palliative situations, 2 development of EMS palliative care policies and clarifying palliative care referral pathways, 2 cost-effectiveness of EMS and palliative care integration. 40 59 66…”

Palliative care models for patients living with advanced cancer: a narrative review for the emergency department clinician

“…Community paramedicine (CP), while part of MIH, involves paramedics working to support and enrich existing programs and care plans with the goal of improving care for patients while decreasing ED visits [77]. This model of CP is still evolving, with several pilot programs working towards different aims depending on geographic location and regulatory body [78][79][80][81]. Some programs require staff, such as paramedics and/or emergency medical technicians (EMTs), to receive additional training, education, and skills to care for patients at home or in alternate destinations (e.g., primary care) [76].…”