Department of Emergency Medicine, University of California San Francisco, San Francisco, California (AB); Healthcare Administration and Interprofessional Leadership, University of California San Francisco, San Francisco, California (MT); Ventura County Emergency Medical Services Agency, Oxnard, California (AS); University of California San Francisco, San Francisco, California (KS).
Prehosp Emerg Care. 2022 May-Jun;26(3):364-369. doi: 10.1080/10903127.2021.1900474. Epub 2021 Mar 30.
To evaluate the effect of a Mobile Integrated Hospice Healthcare (MIHH) program including hospice education and expansion of paramedic scope of practice to use hospice medication kits. Primary outcome was the effect on hospice patient transport to the Emergency Department. Secondary outcomes included reasons for patient transport and review of MIHH kit utilization. In 2015, the project was implemented in Ventura County, California in collaboration with county emergency medical services (EMS) agency, first response/transport organizations, and hospice programs. Paramedic supervisors received 30 hours of hospice training focusing on palliative care, grief and crisis counseling. When 9-1-1 was called for a patient, EMS first responders arrived on scene, determined a patient was enrolled in hospice and then contacted trained MIHH. Six months (2/2015-7/2015) prior to project implementation the percentage of hospice patients transported to the ED averaged 80.3% (98/122). During the first (8/2015-7/2016), second (8/2016-7/2017) and third year (8/2017-7/2018) after project implementation, the percentage of hospice patients transported to the ED was 36.2% (68/188), 33.2% (63/190) and 24.8% (36/145) respectively. A total of 523 hospice patients were cared for by MIHH during this three-year interval. Of those hospice patients transported, the most common reason for transport was fall/trauma. The MIHH hospice kit was only used once in the field. Odds ratio for hospice transportation to the ED before and after project implementation was 0.125 (95% Confidence Interval: 0.077 to 0.201; < 0.0001). This represents an absolute reduction risk of 46.6% (95% Confidence Interval: 38.53% to 54.72%). MIHH decreased the transportation of hospice patients to the ED. MIHH provided hospice education, provided family grief support and developed treatment plans with hospice nurses. An expanded scope of practice, including a paramedic hospice kit, was not contributory to this decrease.
评估一个移动综合临终关怀医疗（MIHH）项目的效果，该项目包括临终关怀教育和扩大护理人员的实践范围，以使用临终关怀药物包。主要结果是对临终关怀患者送往急诊部的影响。次要结果包括患者转运的原因和 MIHH 包利用情况的审查。2015 年，该项目与加利福尼亚州文图拉县的紧急医疗服务（EMS）机构、第一反应/转运组织和临终关怀项目合作在该县实施。护理人员主管接受了 30 小时的临终关怀培训，重点是姑息治疗、悲伤和危机咨询。当有患者拨打 9-1-1 时，EMS 第一反应者到达现场，确定患者已登记入住临终关怀，并联系经过培训的 MIHH。在项目实施前的六个月（2015 年 2 月至 7 月），送往急诊部的临终关怀患者比例平均为 80.3%（98/122）。在项目实施后的第一年（2015 年 8 月至 2016 年 7 月）、第二年（2016 年 8 月至 2017 年 7 月）和第三年（2017 年 8 月至 2018 年 7 月），送往急诊部的临终关怀患者比例分别为 36.2%（68/188）、33.2%（63/190）和 24.8%（36/145）。在这三年期间，共有 523 名临终关怀患者接受了 MIHH 的护理。在送往急诊部的患者中，最常见的转运原因是跌倒/外伤。MIHH 临终关怀套件仅在现场使用过一次。项目实施前后送往急诊部的临终关怀转运的优势比为 0.125（95%置信区间：0.077 至 0.201； < 0.0001）。这代表绝对风险降低了 46.6%（95%置信区间：38.53%至 54.72%）。MIHH 减少了临终关怀患者送往急诊部的人数。MIHH 提供临终关怀教育、提供家庭悲伤支持并与临终关怀护士一起制定治疗计划。扩大实践范围，包括护理人员的临终关怀套件，对这种减少没有贡献。
