Jensen Jan L, Marshall Emily Gard, Carter Alix J E, Boudreau Michelle, Burge Frederick, Travers Andrew H
Prehosp Emerg Care. 2016;20(1):111-6. doi: 10.3109/10903127.2015.1051678. Epub 2015 Aug 17.
To compare system and clinical outcomes before and after an extended care paramedic (ECP) program was implemented to better address the emergency needs of long-term care (LTC) residents. Data were collected from emergency medical services (EMS), hospital, and ten LTC facility charts for two five-month time periods, before and after ECP implementation. Outcomes include: number of EMS patients transported to emergency department (ED) and several clinical, safety, and system secondary outcomes. Statistics included descriptive, chi-squared, t-tests, and ANOVA; α = <0.05. 413 cases were included (before: n = 136, 33%; after n = 277, 67%). Median patient age was 85 years (IQR 77-91 years) and 292/413 (70.7%) were female. The number of transports to ED before implementation was 129/136 (94.9%), with 147/224 (65.6%) after, p < 0.001. In the after period, fewer patients seen by ECP were transported: 58/128 (45.3%) vs. 89/96 (92.7%) of those not seen by ECP, p < 0.001. Hospital admissions were similar between phases: 39/120 (32.5%) vs. 56/213 (29.4%), p = NS, but in the after phase, fewer ECP patients were admitted vs. non-ECP: 21/125 (16.8%) vs. 35/88 (39.8%), p < 0.001. Mean EMS call time (dispatch to arrive ED or clear scene) was shorter before than after: 25 minutes vs. 57 minutes, p < 0.001. In the after period, calls with ECP were longer than without ECP: 1 hour, 35 minutes vs. 30 minutes, p < 0.001. The mean patient ED length-of-stay was similar before and after: 7 hours, 29 minutes compared to 8 hours, 11 minutes; p = NS. In the after phase, ED length-of-stay was somewhat shorter with ECPs vs. no ECPs: 7 hours, 5 minutes vs. 9 hours, p = NS. There were zero relapses after no-transport in the before phase and three relapses from 77 calls not transported in the after phase (3/77, 3.9%); two involved ECP (2/70, 2.8%). Reductions were observed in the number of LTC patients transported to the ED when the ECP program was introduced, with fewer patients admitted to the hospital. EMS calls take longer with ECP involved. The addition of ECP to the LTC model of care appears to be beneficial and safe, with few relapse calls identified.
为比较实施扩展护理护理人员（ECP）项目前后的系统和临床结果，以更好地满足长期护理（LTC）居民的紧急需求。在实施ECP项目前后的两个五个月时间段内，从紧急医疗服务（EMS）、医院和十家LTC机构的病历中收集数据。结果包括：转运至急诊科（ED）的EMS患者数量以及若干临床、安全和系统次要结果。统计方法包括描述性统计、卡方检验、t检验和方差分析；α = <0.05。共纳入413例病例（实施前：n = 136，占33%；实施后n = 277，占67%）。患者中位年龄为85岁（四分位间距77 - 91岁），292/413（70.7%）为女性。实施前转运至ED的次数为129/136（94.9%），实施后为147/224（65.6%），p < 0.001。在实施后阶段，经ECP诊治的患者被转运的较少：58/128（45.3%），而未接受ECP诊治的患者为89/96（92.7%），p < 0.001。各阶段住院情况相似：39/120（32.5%）对56/213（29.4%），p = 无显著差异，但在实施后阶段，接受ECP诊治的患者住院比例低于未接受ECP诊治的患者：21/125（16.8%）对35/88（39.8%），p < 0.001。EMS平均呼叫时间（从调度到抵达ED或清理现场）实施前短于实施后：25分钟对57分钟，p < 0.001。在实施后阶段，有ECP参与的呼叫时间长于无ECP参与的呼叫时间：1小时35分钟对30分钟，p < 0.001。患者在ED的平均住院时间实施前后相似：7小时29分钟对8小时11分钟；p = 无显著差异。在实施后阶段，有ECP参与时患者在ED的住院时间略短于无ECP参与时：7小时5分钟对9小时，p = 无显著差异。实施前未转运患者无复发情况，实施后77次未转运呼叫中有3次复发（3/77，3.9%）；其中2次涉及ECP（2/70，2.8%）。引入ECP项目后，转运至ED的LTC患者数量减少，住院患者也减少。涉及ECP时EMS呼叫时间更长。在LTC护理模式中增加ECP似乎有益且安全，复发呼叫很少。
