Abstract
BackgroundAs demand for Emergency Department (ED) services continues to exceed increases explained by population growth, strategies to reduce ED presentations are being explored. The concept of ambulance paramedics providing an alternative model of care to the current default ‘see and transport to ED’ has intuitive appeal and has been implemented in several locations around the world. The premise is that for certain non-critically ill patients, the Extended Care Paramedic (ECP) can either ‘see and treat’ or ‘see and refer’ to another primary or community care practitioner, rather than transport to hospital. However, there has been little rigorous investigation of which types of patients can be safely identified and managed in the community, or the impact of ECPs on ED attendance.Methods/DesignSt John Ambulance Western Australia paramedics will indicate on the electronic patient care record (e-PCR) of patients attended in the Perth metropolitan area if they consider them to be suitable to be managed in the community. ‘Follow-up’ will examine these patients using ED data to determine the patient’s disposition from the ED. A clinical panel will then develop a protocol to identify those patients who can be safely managed in the community. Paramedics will then assess patients against the derived ECP protocols and identify those deemed suitable to ‘see and treat’ or ‘see and refer’. The ED disposition (and other clinical outcomes) of these ‘ECP protocol identified’ patients will enable us to assess whether it would have been appropriate to manage these patients in the community. We will also ‘track’ re-presentations to EDs within seven days of the initial presentation. This is a ‘virtual experiment’ with no direct involvement of patients or changes in clinical practice. A systems modelling approach will be used to assess the likely impact on ED crowding.DiscussionTo date the efficacy, cost-effectiveness and safety of alternative community-based models of emergency care have not been rigorously investigated. This study will inform the development of ECP protocols through the identification of types of patient presentation that can be considered both safe and appropriate for paramedics to manage in the community.
Highlights
As demand for Emergency Department (ED) services continues to exceed increases explained by population growth, strategies to reduce ED presentations are being explored
This study will inform the development of Extended Care Paramedic (ECP) protocols through the identification of types of patient presentation that can be considered both safe and appropriate for paramedics to manage in the community
Research plan The study will be conducted in several consecutive phases, as follows: Phase 1: Collect baseline data Over a 3 month period, we will include all patients within the Perth metropolitan area attended by SJA-Western Australia (WA) paramedics and transported to one of the11 Perth EDs
Summary
The results of our ‘virtual’ study of ECPs will provide much needed data to better inform decisions about emergency medical services in WA and other jurisdictions. Our project will bring together emergency physicians, ambulance service personnel and primary/community care providers (e.g. general practitioners and community nurses) to collaboratively develop alternative community based pathways of care for a group of patients who would otherwise be routinely (and possibly unnecessarily) transported to the ED. We will aim to develop a clinically appropriate and costeffective alternative model of care for those patients who, despite calling for an ambulance, have health care needs that might be safely managed in the community.
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