Emergency Medical Services
Background: Older adult patients are at a higher risk for falls following a hospital visit and often report confusion about their discharge instructions. Patients transported home by ambulance have been shown to have significantly higher rates of return emergency department (ED) visits than matched controls transported by other means. “Transport PLUS” (T+) is a novel transitions of care program that trains emergency medical technicians (EMTs) to perform two simple assessments — discharge instruction comprehension and home fall safety — for older adult patients being transported home following a hospitalization or ED visit.
Methods: This was a pilot randomized controlled trial (RCT) conducted between January 2017 and August 2018 evaluating the effectiveness of the T+ intervention on reducing rates of self-reported falls at 30 days and return ED visits at 3 days. EMTs from a local ambulance agency were randomized to either the T+ intervention group or to routine care. Eligible patients were those aged 65 and over being transported directly to the home from the study hospital. Follow up phone interviews were conducted with patients or caregivers to assess post encounter falls. Administrative utilization data was used to measure return ED visits.
Results: A total of 52 EMTs were enrolled. A total of 337 patient encounters were performed, 176 intervention and 161 control. Among those that received T+, 61.2% and 17.5% and were found to have a fall safety hazard and discharge comprehension deficiency, respectively. Self-reported falls were 3.06% in the T+ group compared with 14.81% in the control group (p=0.006). 3 day return ED visits were 1.1% in the T+ group compared with 5.0% in the intervention group (p=0.053).
Conclusion: In this pilot RCT, the T+ intervention demonstrated effectiveness at reducing the self-reported falls at 30 days. There was a trend toward reduced 3 day ED returns. Limitations include being a single center study and the small sample size did not allow for adjustment for clustering effects by provider. However, given these promising results from the pilot RCT, a larger multi-site trial is warranted. If proven to be effective, the T+ program could reduce the burden of preventable injuries and return ED visits while expanding the role of EMTs.