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VHA Research

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Is 911 the answer? A retrospective review of emergency medical services use in homecare

What's the challenge?

It is well documented that the Ontario health system is under strain. Patients experience long waits in emergency departments and often receive care in unconventional spaces such as meeting rooms and hallways – this has come to be known as ‘hallway medicine’. The emergency department is the most common point of access for individuals wishing to seek medical care and many of those individuals are transported there using the clinically sophisticated paramedic services. It has been suggested that inappropriate use of emergency departments is a significant contributor of hallway medicine and symptomatic of poor use of system resources. Existing studies of “inappropriate” use of emergency medical services (EMS) provide insights into the extent and clinical criteria used to assess ‘appropriateness’ of use. Much of the available work in this area is informed by the attending physician in the emergency department and is insensitive to the available healthcare services received by individuals in the home or community.

What are we doing?

We are completing a retrospective chart review of events where EMS was called to determine if the situation could have been addressed without transport to the Emergency Department. This work will address a current gap in the literature by providing insights into the type of situations that lead to decisions to call EMS and the outcome of the decision to call for help within a population of individuals receiving homecare services. A review of these events will provide insights that may be valuable for creating evidence-based recommendations on when EMS should be called. These recommendations can be incorporated into training and education for point-of-care staff. Insights from this research can also be used by the organization to create operational support to minimize the unnecessary use of paramedics, thereby preserving the resource for individuals experiencing significant medical events. Reducing unnecessary emergency department visits is one way to address hallway medicine.