Extended Care Paramedic (ECP) programs are increasingly being implemented to enhance the emergency response for residents in long-term care (LTC) facilities. These programs aim to provide specialized on-site care, potentially reducing unnecessary emergency department (ED) visits. A recent study rigorously examined the effectiveness of an ECP program by comparing system and clinical outcomes before and after its implementation in LTC settings. This analysis provides valuable insights into the benefits and impacts of integrating ECP services within the long-term care model.
The study meticulously collected data from emergency medical services (EMS), hospital records, and ten LTC facilities, spanning two five-month periods – one preceding and one following the ECP program’s introduction. Researchers focused on key outcomes, most notably the number of EMS patients transported to the ED, alongside a range of secondary clinical, safety, and system-level indicators. Statistical analysis, employing chi-squared tests, t-tests, and ANOVA, was conducted to determine the significance of observed changes, with a threshold of p < 0.05. The study encompassed 413 cases, with a demographic profile indicating a median patient age of 85 years and a predominantly female population (70.7%).
A significant reduction in ED transports was observed post-ECP implementation. Before the program, an overwhelming 94.9% of EMS patients were transported to the ED. Following the ECP program’s launch, this figure decreased substantially to 65.6% (p < 0.001). Furthermore, within the post-implementation period, a striking difference emerged between patients seen by ECPs and those who were not. Only 45.3% of patients assessed by ECPs were transported, compared to a significantly higher 92.7% of patients not seen by ECPs (p < 0.001). This stark contrast underscores the ECP program’s direct impact on reducing ED transports by providing effective on-site care alternatives.
Interestingly, while overall hospital admission rates remained statistically similar before and after ECP implementation (32.5% vs. 29.4%, p = NS), a notable difference was observed within the post-ECP period. Patients evaluated by ECPs experienced significantly lower hospital admission rates (16.8%) compared to those not seen by ECPs (39.8%, p < 0.001). This suggests that the ECP program not only reduces ED transports but also contributes to a decrease in hospital admissions specifically for patients receiving ECP intervention.
However, the study also revealed an increase in EMS call times with the introduction of the ECP program. The mean EMS call time, measured from dispatch to arrival at the ED or scene clearance, was significantly shorter before ECP implementation (25 minutes) compared to after (57 minutes, p < 0.001). In the post-implementation phase, calls involving ECPs were considerably longer, averaging 1 hour and 35 minutes, versus 30 minutes for calls without ECP involvement (p < 0.001). This increase in call duration is likely attributable to the additional time spent by ECPs on scene for comprehensive patient assessment and on-site treatment.
Despite the longer call times, the mean patient ED length-of-stay showed no significant difference between the pre- and post-ECP periods (7 hours, 29 minutes vs. 8 hours, 11 minutes; p = NS). Similarly, in the post-ECP phase, ED length-of-stay was slightly shorter for patients seen by ECPs compared to those without ECP intervention, but this difference was not statistically significant (7 hours, 5 minutes vs. 9 hours, p = NS). This indicates that while ECPs extend on-scene time, they do not lead to longer ED stays for patients who are transported.
In terms of safety, relapse rates after no-transport decisions were minimal. In the pre-ECP period, there were zero relapses following no-transport decisions. In the post-ECP period, three relapses were reported out of 77 calls where transport was avoided (3.9%), with two of these relapses involving patients who had been seen by an ECP (2.8% of ECP-involved no-transport calls). These low relapse figures suggest that the ECP program’s approach to reducing transports is acceptably safe, with robust assessment protocols in place.
In conclusion, the implementation of an Extended Care Paramedic Program in long-term care facilities demonstrates significant benefits, primarily in reducing the number of LTC residents transported to the emergency department and subsequently admitted to the hospital. While EMS call times are extended with ECP involvement, this appears to be a trade-off for more comprehensive on-site care, without increasing ED length-of-stay or compromising patient safety, as evidenced by low relapse rates. The findings strongly suggest that integrating ECP programs into the LTC model of care is a valuable and safe strategy for enhancing emergency care and optimizing healthcare resource utilization for this vulnerable population.
