Referral pathway of patients aged 75 years and older after a telephone triage by the French emergency medical communication center (SAMU)

Vincent, Adélaïde; Jomard, Nathalie; Haesebaert, Julie; Comte, B; Gilbert, Thomas; Schott, Anne-Marie

doi:10.1016/j.archger.2019.05.018

Cited by 1 publication

(4 citation statements)

References 41 publications

(42 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Indeed, the dispatching physicians are under great pressure due to the distress calls they receive and the large flow of calls, which requires them to be as quick as possible in their referrals. [22][23][24] Transferring older patients to appropriate health centers or outpatient and geriatric care pathways requires that these facilities are available, but medical attention from geriatricians is often delayed. 5 Referral to the ED remains the main recourse for dispatching physicians wishing to hospitalize their patients or to secure care in France.…”

Section: Discussionmentioning

confidence: 99%

“…This can be explained by time constraints, but also technical difficulties in managing a second simultaneous call. Indeed, the dispatching physicians are under great pressure due to the distress calls they receive and the large flow of calls, which requires them to be as quick as possible in their referrals 22–24 . Transferring older patients to appropriate health centers or outpatient and geriatric care pathways requires that these facilities are available, but medical attention from geriatricians is often delayed 5 .…”

Section: Discussionmentioning

confidence: 99%

“…27,28 In a previous observational study, we found that more than half of the calls to the Rhône EMS concerning patients over 75 years of age resulted in a referral to the ED, while among these patients, half (thus a quarter of the total) had a medical reason for the presentation that would have allowed them to be treated as outpatients. 23 Furthermore, we observed that the dispatchers failed to ask some crucial questions to help guide the orientation of older patients' emergency pathway. This included, for example, asking if the patient was autonomous or dependent, if he/she lived alone or with a caregiver, or if he/she had been recently hospitalized.…”

Section: Key Pointsmentioning

confidence: 97%

“…This may particularly be the case for older patients who have more often multiple comorbidities and loss of autonomy. Older patients are very frequent users of EMS, 23,24 which may be due to difficulties in accessing outpatient and geriatric care pathways, or to a lack of knowledge of possible alternatives to referral to the ED. 4,6 Telephone triage may alleviate pressure on the ED by redirecting patients with less urgent needs to other, more appropriate care pathways.…”

Section: Key Pointsmentioning

confidence: 99%

See 3 more Smart Citations

Evaluation of a training program for emergency medical service physician dispatchers to reduce emergency departments visits

Foucaud

Gilbert

Vincent

et al. 2022

J American Geriatrics Society

Self Cite

View full text Add to dashboard Cite

Background Emergency Departments (ED) have seen an increasing number of older patients who are mostly referred following a call to the Emergency Medical Services (EMS). Long waiting times in settings, which are not designed to meet older patients' needs, may increase the risk of hospital‐acquired complications. Unnecessary visits should therefore be avoided as much as possible. The objective of the study was to evaluate whether a program to provide geriatric knowledge and tools to the dispatching physicians of the EMS could decrease ED referrals of older patients. Methods Design: Before‐and‐after study with two 6‐month periods before and after intervention. Participants: All calls received by a dispatching physician of the Rhône EMS from 8 am to 6 pm concerning patients aged 75 years or above during the study period. Intervention: A program consisting of training dispatching physicians in the specific care of older patients and the developing, with a multidisciplinary team, of specific tools for dispatching physicians. Outcome: Proportion of ED referrals of patients aged 75 years or above after a call to the EMS. Results A total of 2671 calls to the Rhône EMS were included corresponding to 1307 and 1364 patients in the pre‐and post‐intervention phases, respectively. There was no significant difference in the proportion of referrals to the ED between the pre‐intervention (61.7%) and the post‐intervention (62.8%) phases (p = 0.57). Contact of the patients with their General Practitioner (GP) in the month preceding the call was associated with a 22% reduced probability of being referred to an ED. Conclusions No beneficial effect of the intervention was demonstrated. This strategy of intervention is probably not effective enough in such time‐constraint environment. Other strategies with a specific parallel dispatching of geriatric calls by geriatricians should be tested to avoid these unnecessary ED referrals. Trial registration: ClinicalTrials NCT02712450.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%