Community frailty response service: the ED at your front door

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Abstract

We describe the expansion and adaptation of a frailty response team to assess older people in their usual place of residence. The team had commenced a weekend service to a limited area in February 2020. As a consequence of demand related to the COVID-19 pandemic, we expanded it and adapted the model of care to provide a 7-day service to our entire catchment area. Five hundred and ninety two patient reviews have been completed in the first 105 days of operation with 43 patients transferred to hospital for further investigation or management following assessment.

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Most cited references 3

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Effectiveness of paramedic practitioners in attending 999 calls from elderly people in the community: cluster randomised controlled trial.

Abigail Perrin, Emma Knowles, Simon Dixon … (2007)

To evaluate the benefits of paramedic practitioners assessing and, when possible, treating older people in the community after minor injury or illness. Paramedic practitioners have been trained with extended skills to assess, treat, and discharge older patients with minor acute conditions in the community. Cluster randomised controlled trial involving 56 clusters. Weeks were randomised to the paramedic practitioner service being active (intervention) or inactive (control) when the standard 999 service was available. A large urban area in England. 3018 patients aged over 60 who called the emergency services (n=1549 intervention, n=1469 control). Emergency department attendance or hospital admission between 0 and 28 days; interval from time of call to time of discharge; patients' satisfaction with the service received. Overall, patients in the intervention group were less likely to attend an emergency department (relative risk 0.72, 95% confidence interval 0.68 to 0.75) or require hospital admission within 28 days (0.87, 0.81 to 0.94) and experienced a shorter total episode time (235 v 278 minutes, 95% confidence interval for difference -60 minutes to -25 minutes). Patients in the intervention group were more likely to report being highly satisfied with their healthcare episode (relative risk 1.16, 1.09 to 1.23). There was no significant difference in 28 day mortality (0.87, 0.63 to 1.21). Paramedics with extended skills can provide a clinically effective alternative to standard ambulance transfer and treatment in an emergency department for elderly patients with acute minor conditions. ISRCTN27796329 [controlled-trials.com].

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Home Visit-Based Community Paramedicine and Its Potential Role in Improving Patient-Centered Primary Care: A Grounded Theory Study and Framework

Katie N Dainty, M Bianca Seaton, Ian R Drennan … (2018)

Objective Community paramedicine ( CP ) is a model of community‐based health care being used around the world. Our objective was to study the patient perspective and valuation of this type of program to understand its potential value for primary care innovation in the future. Study Setting The EPIC community paramedicine program is a partnership between primary care physicians and specially trained community paramedics, designed to provide in‐home support for complex chronic disease patients in Ontario, Canada. Study Design As part of an ongoing clinical trial we designed an embedded qualitative evaluation using constructionist grounded theory methodology. Data Collection Methods Data collection included in‐depth interviews with 30 patients and/or family members and 60 hours of observation. Principal Findings The health care needs of this complex population are largely attributes that impact a patient's quality of life—including recognition of their vulnerability, providing a safety‐net in times of exacerbation and health education and accountability. This seems to be facilitated by a relationship with a dedicated provider that increases continuity of care. Conclusions Home‐based community paramedicine programs like EPIC appear to be able to create a patient‐centered, safe, responsive therapeutic relationship that is often not possible within the standard primary health care system.

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Urgent care axis for the older adult: where is best to target interventions?

Jonathan Bunn, Susan Jane Croft, Colin O'Keeffe … (2019)

We explored the urgent care axis across EDs in Yorkshire and Humber (Y&H) for patients aged ≥75 years to identify where interventions could be targeted to prevent ED attendances and inpatient admissions.

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Author and article information

Journal

Journal ID (nlm-ta): Emerg Med J

Journal ID (iso-abbrev): Emerg Med J

Journal ID (hwp): emermed

Journal ID (publisher-id): emj

Title: Emergency Medicine Journal : EMJ

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Print): 1472-0205

ISSN (Electronic): 1472-0213

Publication date (Print): September 2020

Publication date (Electronic): 24 September 2020

Electronic Location Identifier: emermed-2020-210005

Affiliations

[1 ]departmentEmergency Department , Saint Vincent's University Hospital , Dublin, Ireland

[2 ]departmentOccupational Therapy , Saint Vincent's University Hospital , Dublin, Ireland

[3 ]departmentMedicine for Older People , Saint Vincent's University Hospital , Dublin, Ireland

[4 ]departmentSchool of Medicine , University College Dublin - National University of Ireland , Dublin, Ireland

[5 ]HSE National Ambulance Service , Dublin, Ireland

[6 ]departmentPalliative Medicine , Saint Vincent's University Hospital , Dublin, Ireland

[7 ]departmentDepartment of Medicine , Saint Vincent's University Hospital , Dublin, Ireland

[8 ]departmentInfectious Diseases , Saint Vincent's University Hospital , Dublin, Ireland

Author notes

[Correspondence to ] Dr Rosa McNamara, Emergency Department, Saint Vincent's University Hospital, Dublin D04 N2E0, Ireland; rosamcnamara@ 123456gmail.com

Author information

Rosa McNamara http://orcid.org/0000-0002-7803-0483

Shane O'Hanlon http://orcid.org/0000-0002-9270-2768

Article

Publisher ID: emermed-2020-210005

DOI: 10.1136/emermed-2020-210005

PMC ID: 7517235

SO-VID: b5909f75-06de-4656-af1f-3ee40286a2f5

License:

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.