scholarly journals LO20: The characteristics, clinical course and disposition of long-term care patients treated by paramedics during an emergency call: Exploring the potential impact of community paramedicine

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S14-S14
Author(s):  
S. Leduc ◽  
G. Wells ◽  
V. Thiruganasambandamoorthy ◽  
Z. Cantor ◽  
P. Kelly ◽  
...  
Keyword(s):  
Long Term Care ◽  
Clinical Course ◽  
Random Number Generator ◽  
Vital Signs ◽  
Opioid Analgesics ◽  
Emergency Call ◽  
X Rays ◽  
Term Care ◽  
Medical Directives

Introduction: An increasing number of Canadian paramedic services are creating Community Paramedic programs targeting treatment of long-term care (LTC) patients on-site. We explored the characteristics, clinical course and disposition of LTC patients cared for by paramedics during an emergency call, and the possible impact of Community Paramedic programs. Methods: We completed a health records review of paramedic call reports and emergency department (ED) records between April 1, 2016 and March 31, 2017. We utilized paramedic dispatch data to identify emergency calls originating from LTC centers resulting in transport to one of the two EDs of the Ottawa Hospital. We excluded patients with absent vital signs, a Canadian Triage and Acuity Scale (CTAS) score of 1, and whose transfer to hospital were deferrable or scheduled. We stratified remaining cases by month and selected cases using a random number generator to meet our apriori sample size. We collected data using a piloted standardized form. We used descriptive statistics and categorized patients into groups based on the ED care received and if the treatment received fit into current paramedic medical directives. Results: Characteristics of the 381 included patients were mean age 82.5 years, 58.5% female, 59.7% hypertension, 52.6% dementia and 52.1% cardiovascular disease. On arrival at hospital, 57.7% of patients waited in offload delay for a median time of 45 minutes (IQR 33.5-78.0). We could identify 4 groups: 1) Patients requiring no treatment or diagnostics in the ED (7.9%); 2) Patients receiving ED treatment within current paramedic medical directives and no diagnostics (3.2%); 3) Patients requiring diagnostics or ED care outside current paramedic directives (54.9%); and 4) patients requiring admission (34.1%). Most patients were discharged from the ED (65.6%), and 1.1% died. The main ED diagnoses were infection (18.6%) and musculoskeletal injury (17.9%). Of the patients that required ED care but were discharged, 64.1% required x-rays, 42.1% CT, and 3.4% ultrasound. ED care included intravenous fluids (35.7%), medication (67.5%), antibiotics (29.4%), non-opioid analgesics (29.4%) and opioids (20.7%). Overall, 11.1% of patients didn't need management beyond current paramedic capabilities. Conclusion: Many LTC patients could receive care by paramedics on-site within current medical directives and avoid a transfer to the ED. This group could potentially grow using Community Paramedics with an expanded scope of practice.

scholarly journals Clinical pictures, treatments, resource use, and costs of norovirus gastroenteritis in long-term care facilities: A survey with a chart review in Japan

2020 ◽  
Author(s):  
Saori Fujiki ◽  
Tatsuro Ishizaki ◽  
Takeo Nakayama
Keyword(s):  
Drug Cost ◽  
Resource Use ◽  
Long Term Care ◽  
Clinical Course ◽  
Total Drug ◽  
Term Care ◽  
Total Drug Cost ◽  
Norovirus Gastroenteritis ◽  
Care Facilities

Abstract Background Outbreaks of norovirus infection can have detrimental impacts on long-term care facilities. This study investigated the incidence, clinical picture, treatment, resource use, and costs of norovirus gastroenteritis in long-term care facilities. Methods Nineteen facilities in Osaka and Kyoto, Japan participated in questionnaire surveys conducted between 2009 and 2011 regarding the incidence of norovirus gastroenteritis. From clinical charts, the characteristics, symptoms, and treatment of infected residents were analyzed. Total drug cost per infected resident was calculated by multiplying the unit price for each drug by the daily dose and the number of days administered and summing the costs for each drug (USD 1 = JPY 100). Results Over the 3-year period, 8 outbreaks of norovirus gastroenteritis occurred in 6 facilities. The mean clinical course of 107 infected residents in five facilities that granted permission to examine patients’ medical records was 4 days, with all but one resident presenting with vomiting and/or diarrhea, and 84 (79%) also presenting with associated symptoms. Of 107 infected residents, 72 (67%) were isolated. The proportion of infected residents isolated varied from 50% to 100% depending on the facility. Of the infected residents, 81 (76%) received some type of medication, the most common being infusion (67 patients, 63%) and antibiotics (30 patients, 28%). The median total cost of all drugs administered was USD 4.4, and the median drug cost per infected resident per day was USD 2.0. Total drug cost over the entire treatment period was the highest for antibiotics, at USD 8.6. Conclusion Clinical course was similar to those of norovirus cases examined at other facilities. The majority of infected residents received some type of medication. Although the economic burden was not large, not a few infected residents were given antibiotics, which are ineffective for norovirus.

scholarly journals Clinical pictures, treatments, and resource use of norovirus gastroenteritis in long-term care facilities: A survey with a chart review in Japan

2020 ◽  
Author(s):  
Saori Fujiki ◽  
Tatsuro Ishizaki ◽  
Takeo Nakayama
Keyword(s):  
Drug Cost ◽  
Resource Use ◽  
Long Term Care ◽  
Clinical Course ◽  
Total Drug ◽  
Term Care ◽  
Total Drug Cost ◽  
Norovirus Gastroenteritis ◽  
Care Facilities

Abstract Background: Outbreaks of norovirus infection can have detrimental impacts on long-term care facilities. This study investigated the incidence, clinical picture, treatment and resource use of norovirus gastroenteritis in long-term care facilities.Methods: Nineteen facilities in Osaka and Kyoto, Japan participated in questionnaire surveys conducted between 2009 and 2011 regarding the incidence of norovirus gastroenteritis. From clinical charts, the characteristics, symptoms, and treatment of infected residents were analyzed. Total drug cost per infected resident was calculated by multiplying the unit price for each drug by the daily dose and the number of days administered and summing the costs for each drug (USD 1 = JPY 100).Results: Over the 3-year period, 8 outbreaks of norovirus gastroenteritis occurred in 6 facilities. The mean clinical course of 107 infected residents in five facilities that granted permission to examine patients’ medical records was 4 days, with all but one resident presenting with vomiting and/or diarrhea, and 84 (79%) also presenting with associated symptoms. Of 107 infected residents, 72 (67%) were isolated. The proportion of infected residents isolated varied from 50% to 100% depending on the facility. Of the infected residents, 81 (76%) received some type of medication, the most common being infusion (67 patients, 63%) and antibiotics (30 patients, 28%). The median total cost of all drugs administered was USD 4.4, and the median drug cost per infected resident per day was USD 2.0. Total drug cost over the entire treatment period was the highest for antibiotics, at USD 8.6.Conclusion: Clinical course was similar to those of norovirus cases examined at other long-term care facilities. The majority of infected residents received some type of medication. Although the economic burden was not large, not a few infected residents were given antibiotics, which are ineffective for norovirus.

scholarly journals Clinical pictures, treatments and resource use of norovirus gastroenteritis in long-term care facilities: A survey with a chart review in Japan

2020 ◽  
Author(s):  
Saori Fujiki ◽  
Tatsuro Ishizaki ◽  
Takeo Nakayama
Keyword(s):  
Drug Cost ◽  
Resource Use ◽  
Long Term Care ◽  
Clinical Course ◽  
Total Drug ◽  
Term Care ◽  
Total Drug Cost ◽  
Norovirus Gastroenteritis ◽  
Care Facilities

Abstract Background Outbreaks of norovirus infection can have detrimental impacts on long-term care facilities. This study investigated the incidence, clinical picture, treatment, resource use, and costs of norovirus gastroenteritis in long-term care facilities. Methods Nineteen facilities in Osaka and Kyoto, Japan participated in questionnaire surveys conducted between 2009 and 2011 regarding the incidence of norovirus gastroenteritis. From clinical charts, the characteristics, symptoms, and treatment of infected residents were analyzed. Total drug cost per infected resident was calculated by multiplying the unit price for each drug by the daily dose and the number of days administered and summing the costs for each drug (USD 1 = JPY 100). Results Over the 3-year period, 8 outbreaks of norovirus gastroenteritis occurred in 6 facilities. The mean clinical course of 107 infected residents in five facilities that granted permission to examine patients’ medical records was 4 days, with all but one resident presenting with vomiting and/or diarrhea, and 84 (79%) also presenting with associated symptoms. Of 107 infected residents, 72 (67%) were isolated. The proportion of infected residents isolated varied from 50% to 100% depending on the facility. Of the infected residents, 81 (76%) received some type of medication, the most common being infusion (67 patients, 63%) and antibiotics (30 patients, 28%). The median total cost of all drugs administered was USD 4.4, and the median drug cost per infected resident per day was USD 2.0. Total drug cost over the entire treatment period was the highest for antibiotics, at USD 8.6. Conclusion Clinical course was similar to those of norovirus cases examined at other facilities. The majority of infected residents received some type of medication. Although the economic burden was not large, not a few infected residents were given antibiotics, which are ineffective for norovirus.

scholarly journals Clinical pictures, treatments, resource use, and costs of norovirus gastroenteritis in long-term care facilities: A survey with a chart review in Japan

2019 ◽  
Author(s):  
Saori Fujiki ◽  
Tatsuro Ishizaki ◽  
Takeo Nakayama
Keyword(s):  
Drug Cost ◽  
Resource Use ◽  
Long Term Care ◽  
Clinical Course ◽  
Total Drug ◽  
Term Care ◽  
Total Drug Cost ◽  
Norovirus Gastroenteritis ◽  
Care Facilities

Abstract Background Outbreaks of norovirus infection can have detrimental impacts on long-term care facilities. This study investigated the incidence, clinical picture, treatment, resource use, and costs of norovirus gastroenteritis in long-term care facilities. Methods Nineteen facilities in Osaka and Kyoto, Japan participated in questionnaire surveys conducted between 2009 and 2011 regarding the incidence of norovirus gastroenteritis. From clinical charts, the characteristics, symptoms, and treatment of infected residents were analyzed. Total drug cost per infected resident was calculated by multiplying the unit price for each drug by the daily dose and the number of days administered and summing the costs for each drug (USD 1 = JPY 100). Results Over the 3-year period, 8 outbreaks of norovirus gastroenteritis occurred in 6 facilities. The mean clinical course of 107 infected residents in five facilities that granted permission to examine patients’ medical records was 4 days, with all but one resident presenting with vomiting and/or diarrhea, and 84 (79%) also presenting with associated symptoms. Of 107 infected residents, 72 (67%) were isolated. The proportion of infected residents isolated varied from 50% to 100% depending on the facility. Of the infected residents, 81 (76%) received some type of medication, the most common being infusion (67 patients, 63%) and antibiotics (30 patients, 28%). The median total cost of all drugs administered was USD 4.4, and the median drug cost per infected resident per day was USD 2.0. Total drug cost over the entire treatment period was the highest for antibiotics, at USD 8.6. Conclusion Clinical course was similar to those of norovirus cases examined at other facilities. The majority of infected residents received some type of medication. Although the economic burden was not large, not a few infected residents were given antibiotics, which are ineffective for norovirus.

Working With Resistance and Encouraging Buy-In to New Programs

2011 ◽  
Vol 16 (1) ◽  
pp. 18-21
Author(s):  
Sara Joffe
Keyword(s):  
Long Term Care ◽  
Term Care ◽  
Optimal Outcomes ◽  
Speech Language Pathologist

In order to best meet the needs of older residents in long-term care settings, clinicians often develop programs designed to streamline and improve care. However, many individuals are reluctant to embrace change. This article will discuss strategies that the speech-language pathologist (SLP) can use to assess and address the source of resistance to new programs and thereby facilitate optimal outcomes.

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