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Outcomes of a Community Paramedic Service to Support Emergency Department Discharge: A Case Series
Introduction: Interdisciplinary health care teams comprised of community paramedics deliver person-centered care, supporting discharge from emergency department (ED). The community paramedic (CP) scope enables post-ED disease management, in-home clinical assessment, preventative or rehabilitative care, and needs-based interventions. In 2018, a CP program was developed in Cape Breton Nova Scotia to support ED discharge. Our objective was to describe the population served and return to ED outcomes at multiple time points for those who received care.
Methods: This was a retrospective case series of ED referrals to a CP-supportive discharge service between December 18, 2018 and May 1, 2023. A chart review of paramedic electronic patient care records was conducted. Patients could be referred at the discretion of the ED physician. Referrals from in-patient units and specialist clinics were excluded. The primary outcome was return to ED measured at 72 hours & 30 days.
Results: This analysis included 244 ED referrals. 53% (n=166) of referrals were female and the mean age was 73.115.5 years (range 15-101 years). The mean clinical frailty scale score was 4.01.7 (living with very mild frailty). There were 514 CP encounters for the 244 referrals (mean 2.1 visits per patient). Infectious disease related diagnoses (e.g., urinary tract infections and cellulitis) made up 17.6% of referrals. Return to ED was observed for 20% (n=50) of patients, accounting for 59 ED readmissions (22 were within 72 hours post-discharge, and 37 were within 30 days).
Conclusion: CPs provided post-ED care to a diverse group of patients with a comparable 30-day return to ED to other studies. Whether the service prevents and/or reduces duration of hospital admission requires further exploration. CPs may act as a safety net for some patients transitioning from ED to home.
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