Results from a recent study suggest that collaboration between emergency medical services (EMS) and primary care physicians (PCP) could reduce the number of unnecessary hospital transports of assisted living residents after a fall.
In this study, the protocol recommended nontransport for more than half of the fallen residents participating in the study. The effects were surprising.
Falls are the leading cause of injury and death among older adults in the United States, according to the Centers for Disease Control and Prevention (CDC). Older adults fell 29 million times in just 2014 alone.
The National Center for Assisted Living says that 20 to 30 percent of falls result in moderate to severe injury, such as broken bones, hip fractures and head injuries. In fact, most fractures in older adults are the result of falling. Falls are responsible for 95 percent of hip fracture.
These injuries cause significant disability, loss of mobility and independence, and decreased quality of life. These falls are also expensive, costing an estimated $31 billion in Medicare costs each year.
On the other hand, the statistics presented by the National Center for Assisted Living mean that 70 to 80 percent of falls do not cause moderate to severe injury, and this suggests that fallen individuals may not need to travel all the way to a hospital to receive the care they need. This is especially true for residents of assisted living facilities that typically staff nurses and other medical professionals who can render care.
Patients living in assisted living facilities have a higher incidence of falls because they tend to be older, have more complex and chronic conditions, and have more difficulty in ambulating than older adults living in their own homes. Most assisted living facilities have high standards of patient care and protocols that focus on reducing patient falls.
Following protocols usually results in transporting the resident to the emergency department (ED), even when the resident is not seriously ill or injured. Unnecessary transportation of residents to the ED increases costs and uses resources better utilized elsewhere.
Researchers in this study evaluated whether healthcare professionals could avoid the unnecessary transport of older adults. Specifically, the scientists developed a protocol to reduce unnecessary transport of assisted living facility residents that had ground-level falls.
The protocol focused on improving collaboration between EMS and the resident's primary care physician. After implementing the protocol, the researchers noted that the improved collaboration resulted in fewer unnecessary transports.
The researchers performed a prospective cohort study using retrospective data to evaluate the protocol. They collected a convenience sample of people living in 22 assisted living facilities under the care of one group of primary care physicians. The facilities are located within one large county with a single EMS system.
In the study, paramedics providing EMS services used a protocol that involved talking with the PCP via telephone. The researchers measured the number of transports following a fall, and the number of tine-sensitive conditions in residents not transported to the hospital. The researchers used descriptive statistics to analyze data and classify patients according to whether they received appropriate care.
Of the 1,473 residents eligible for the study, 953 agreed to participate. In the 43 months of the study, 359 residents had 840 falls. The new protocol recommended against transport after 553 of these 840 falls.
Eleven of the patients had time-sensitive conditions, and the paramedic conversed with the PCP in nine of these patients. The researchers found that 99.3 percent of patients for whom the protocol recommended nontransport received appropriate care.
Not all facilities have the resources to implement such a program, and this limits widespread use of the protocol.
