Transport outcomes and dispatch determinants in a paramedic long-term care program: a pilot study

ABSTRACT Objectives: Long-term care (LTC) patients are often sent to emergency departments (EDs) by ambulance. In this novel extended care paramedic (ECP) program, specially trained paramedics manage LTC patients on site. The objective of this pilot study was to describe the dispatch and disposition of LTC patients treated by ECPs and emergency paramedics. Methods: Data were collected from consecutive calls to 15 participating LTC facilities for 3 months. Dispatch determinants, transport rates, and relapse rates were described for LTC patients attended by ECPs or emergency paramedics. ECP involvement in end-of-life care was identified. Results: Of 238 eligible calls, 140 (59%) were attended by an ECP and 98 (41%) by emergency paramedics. Although the top three determinants were the same in each group, the overall distribution of dispatch determinants and acuity differed. In the ECP cohort, 98 of 140 (70%) were treated and released, 33 of 140 (24%) had “facilitated transfer” arranged by an ECP, and 9 of 140 (6%) were immediately transported to the ED by ambulance. In the emergency paramedic cohort, 77 of 98 (79%) were immediately transported to the ED and 21 of 98 (21%) were not transported. In the ECP group, 6 of 98 (6%) patients not transported triggered a 911 call within 48 hours for a related clinical reason, although none of the patients not transported by emergency paramedics relapsed. Conclusion: ECP involvement in LTC calls was found to reduce transports to the ED with a low rate of relapse. These pilot data generated hypotheses for future study, including determination of appropriate populations for ECP care and analysis of appropriate and safe nontransport.

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Scrapped Long-Term Care Program Gets Scrutiny

Family Practice News ◽

10.1016/s0300-7073(11)70989-6 ◽

2011 ◽

Vol 41 (19) ◽

pp. 49

Author(s):

FRANCES CORREA

Keyword(s):

Long Term Care ◽

Care Program ◽

Term Care

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Cost of shifting from healthcare to long-term care in later life across major diseases: analysis of end-of-life care during the last 24 months of life

Journal of Rural Medicine ◽

10.2185/jrm.2955 ◽

2018 ◽

Vol 13 (1) ◽

pp. 40-47 ◽

Cited By ~ 2

Author(s):

Tomoko Terada ◽

Keiko Nakamura ◽

Kaoruko Seino ◽

Masashi Kizuki ◽

Naohiko Inase

Keyword(s):

End Of Life ◽

End Of Life Care ◽

Long Term Care ◽

Later Life ◽

Life Care ◽

Term Care

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The Impact of Enhanced Antimicrobial Stewardship Support on Antibiotic Starts in Long-Term Care Facilities

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1212 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s527-s527

Author(s):

Gabriela Andujar-Vazquez ◽

Kirthana Beaulac ◽

Shira Doron ◽

David R Snydman

Keyword(s):

Public Health ◽

Pilot Study ◽

Infection Control ◽

Antimicrobial Stewardship ◽

Long Term Care ◽

Medical Center ◽

Term Care ◽

Care Facilities ◽

The Impact

Background: The Tufts Medical Center Antimicrobial Stewardship (ASP) Team has partnered with the Massachusetts Department of Public Health (MDPH) to provide broad-based educational programs (BBEP) to long-term care facilities (LTCFs) in an effort to improve ASP and infection control practices. LTCFs have consistently expressed interest in individualized and hands-on involvement by ASP experts, yet they lack resources. The goal of this study was to determine whether “enhanced” individualized guidance provided by an ASP expert would lead to antibiotic start decreases in LTCFs participating in our pilot study. Methods: A pilot study was conducted to test the feasibility and efficacy of providing enhanced ASP and infection control practices to LTCFs. In total, 10 facilities already participating in MDPH BBEP and submitting monthly antibiotic start data were enrolled, were stratified by bed size and presence of dementia unit, and were randomized 1:1 to the “enhanced” group (defined as reviewing protocols and antibiotic start cases, providing lectures and feedback to staff and answering questions) versus the “nonenhanced” group. Antibiotic start data were validated and collected prospectively from January 2018 to July 2019, and the interventions began in April 2019. Due to staff turnover and lack of engagement, intervention was not possible in 2 of the 5 LTCFs randomized to the enhanced group, which were therefore analyzed as a nonenhanced group. An incidence rate ratios (IRRs) with 95% CIs were calculated comparing the antibiotic start rate per 1,000 resident days between periods in the pilot groups. Results: The average bed sizes for enhanced groups versus nonenhanced groups were 121 (±71.0) versus 108 (±32.8); the average resident days per facility per month were 3,415.7 (±2,131.2) versus 2,911.4 (±964.3). Comparatively, 3 facilities in the enhanced group had dementia unit versus 4 in the nonenhanced group. In the per protocol analysis, the antibiotic start rate in the enhanced group before versus after the intervention was 11.35 versus 9.41 starts per 1,000 resident days (IRR, 0.829; 95% CI, 0.794–0.865). The antibiotic start rate in the nonenhanced group before versus after the intervention was 7.90 versus 8.23 antibiotic starts per 1,000 resident days (IRR, 1.048; 95% CI, 1.007–1.089). Physician hours required for ASP for the enhanced group totaled 8.9 (±2.2) per facility per month. Conclusions: Although the number of hours required for intervention by an expert was not onerous, maintaining engagement proved difficult and in 2 facilities could not be achieved. A statistically significant 20% decrease in the antibiotic start rate was achieved in the enhanced group after interventions, potentially reflecting the benefit of enhanced ASP support by an expert.Funding: This study was funded by the Leadership in Epidemiology, Antimicrobial Stewardship, and Public Health (LEAP) fellowship training grant award from the CDC.Disclosures: None

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Kelly, James R., Jr.

Encyclopedia of Social Work ◽

10.1093/acrefore/9780199975839.013.1479 ◽

2021 ◽

Author(s):

Sadye L. M. Logan

Keyword(s):

United States ◽

Long Term Care ◽

The United States ◽

Veterans Administration ◽

Term Care ◽

Extended Care

James R. Kelly, Jr. (1934–2002) undertook pioneering work in the development and administration of the Veterans Administration (VA) Extended Care programs that has basically shaped the modalities of long-term care now available to veterans across the United States.

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Educational effects of end-of-life care education program for caring staff of long-term care facilities

Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics ◽

10.3143/geriatrics.51.191 ◽

2014 ◽

Vol 51 (2) ◽

pp. 191-191

Author(s):

Yoshihisa Hirakawa ◽

Kazumasa Uemura

Keyword(s):

End Of Life ◽

Education Program ◽

End Of Life Care ◽

Long Term Care ◽

Life Care ◽

Term Care ◽

Care Education ◽

Care Facilities

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Correction: Technical-efficiency analysis of end-of-life care in long-term care facilities within Europe: A cross-sectional study of deceased residents in 6 EU countries (PACE)

PLoS ONE ◽

10.1371/journal.pone.0208199 ◽

2018 ◽

Vol 13 (11) ◽

pp. e0208199 ◽

Cited By ~ 1

Author(s):

Anne B. Wichmann ◽

Eddy M. M. Adang ◽

Kris C. P. Vissers ◽

Katarzyna Szczerbińska ◽

Marika Kylänen ◽

...

Keyword(s):

End Of Life Care ◽

Long Term Care ◽

Cross Sectional Study ◽

Efficiency Analysis ◽

Life Care ◽

Sectional Study ◽

Cross Sectional ◽

Term Care ◽

Care Facilities

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END-OF-LIFE CARE PREFERENCES AND WELL-BEING IN LONG-TERM CARE RESIDENTS

Innovation in Aging ◽

10.1093/geroni/igz038.2474 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S669-S669

Author(s):

Kelly Shryock ◽

Jacinta Dickens ◽

Anisha Thomas ◽

Suzanne Meeks

Keyword(s):

Quality Of Life ◽

Positive Affect ◽

End Of Life ◽

End Of Life Care ◽

Long Term Care ◽

Well Being ◽

Life Care ◽

Term Care

Abstract Research on end-of-life care in nursing homes comes largely from the viewpoint of staff or family members. We examined patient perspectives on end-of-life care, preferences for care, and quality of life in long-term care settings. We hypothesized that fulfillment of the Self Determination Theory (SDT) needs of autonomy, competence, and relatedness would be related to better well-being and that the degree to which end-of-life care preferences are seen as possible in the setting would be related to SDT need fulfillment and well-being. Preliminary data, collected from older individuals at the end of life (over 55, presence of significant chronic disease, in long term care setting) (n= 72), demonstrated that autonomy, competence, and relatedness measures were moderately and significantly correlated with well-being as measured by life satisfaction, higher positive affect, lower negative affect, and overall quality of life measures The degree to which residents believed that their end-of-life care preferences could be honored in the setting was also significantly correlated with autonomy, competence, relatedness, positive affect, and psychological quality of life. These results are consistent with SDT and suggest that if long term care settings can promote autonomy, connection, and competence in making end of life decisions, possibly by discovering and fulfilling preferences for end of life care, individuals who end their lives on those settings have potential for greater satisfaction and happiness. These results suggest that SDT is a useful framework for ongoing research on how to improve the end of life experiences of older adults in long term care.

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