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. 2023 Feb;71(2):484-495.
doi: 10.1111/jgs.18101. Epub 2022 Nov 1.

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

Amandine Foucaud  1 , Thomas Gilbert  1   2 , Adélaïde Vincent  3 , Nathalie Jomard  1 , Brigitte Comte  3 , Sylvie Porthault  4 , Gaële Comte  4 , Odile Theurey  4 , Pierre-Yves Gueugniaud  4 , Laura Bourelly  3 , Muriel Rabilloud  5   6 , Florent Boutitie  5 , Marion Douplat  7 , Ouazna Tassa  8 , Julie Haesebaert  2   8 , Anne Termoz  2   8 , Anne-Marie Schott  2   8
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Evaluation of a training program for emergency medical service physician dispatchers to reduce emergency departments visits

Amandine Foucaud et al. J Am Geriatr Soc. 2023 Feb.

Abstract

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.

Keywords: dispatching physicians; emergency department; older; telephone triage.

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References

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