Tools Development for Geriatric Emergency Regulation

NCT02712450 | Completed

• 1 other identifier: 69HCL14_0449
• Study Type: observational
• Target: 2,279
• Locations: 1 country
• Sites: 1

Brief Summary

According to surveys, 13% to 20% of the Service Médical d'Urgence (SAMU) centre 15 (French 911) calls concern elderly patients above 75 years of age. For these patients, the clinical pathway should be decided on the basis of the symptomatology described during the call, but also with the gathering of specific data such as medical social and psychological evaluation. These items allow the regulating doctor to assess comorbidity, on-going treatment, psycho-cognitive status, previous hospitalisations, social situation, and patient expectations and needs. However, data collected in order to assess the situation on the phone and take the orientation decision are mainly limited to the severity of clinical symptoms. Medical, psychological and social aspects are rarely gathered, for several reasons :

• Phone call shortness : emergency calls should be treated quickly
• Regulating doctors are not trained to take in account the specificities or geriatric patients in their decision making. Besides, they are not informed about alternatives to the hospital emergency department, such as "geriatric channel" system. An observational study was performed in 2012 on 692 calls about elderly patients referred to the SAMU centre 15 during 7 days : 63% of these patients were transferred to an emergency department. Regardless of severe cases "hospital regulation", 55% of the least serious cases ("liberal regulation") were transferred to an emergency department. Regulation is inadequate to elderly patients for whom 1) the situation assessment and the appropriate decision making require specific items that are not known by regulating doctors, 2) the medical care and the clinical pathway could be improved by the knowledge of on-field "geriatric channel", 3) the emergency department care is particularly long, 4) and could be pernicious to younger patients. 1920 patients will be recruited between January 2016 and August 2017, including a 6 months wash-out in order to train regulating doctors. This training will include geriatric patient's specificities, and geriatric channels. A 12% difference between the 2 groups (before and after the training) is expected, considering a 80% statistical power. The design is a time series experiment.

Conditions

Emergency Geriatric Care

Keywords

geriatric; emergency; clinical pathway; regulation; SAMU; training

Outcome Measures

Primary Outcomes (1)

• Proportion of patients sent to an emergency department

  The training course efficiency (which contains specific regulation tools and emergency regulation doctors formation) will be assessed by evaluating the proportion of 75 years old patients and older sent to an emergency department after a liberal regulation.

  24 hours after patient's call

Secondary Outcomes (7)

• Duration of the hospital stay in emergency department

  7 days after patient's call

• Occurence of non-programmed hospitalization in emergency department

  7 days after patient's call

• Geriatric channel utilisation rate

  24 hours after patient's call

• Training course feasibility

  24 hours after patient's call

• Medical cost for patient

  7 days after patient's call

Study Arms (2)

Control group

* Patients included from January 2016 to August 2016 * Before regulating doctors training course

Experimental group

* Patients included from January 2017 to August 2017 * After regulating doctors training course

Eligibility Criteria

• Age: 75 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

Elderly patients calling SAMU

You may qualify if:

• Patient above 75 years olds
• Patient calling for a liberal regulation
• Patient calling between 8 a.m. and 6 p.m. from monday to friday

You may not qualify if:

• Patient calling for vital emergency (hospital regulation)
• Patient calling for inter-hospital transport

Sponsors & Collaborators

• Hospices Civils de Lyon: lead

Study Sites (1)

Service Gériatrie - Hôpital Edouard Herriot, Hospices Civils de Lyon

Lyon, 69003, France

Location

Related Publications (1)

• Foucaud A, Gilbert T, Vincent A, Jomard N, Comte B, Porthault S, Comte G, Theurey O, Gueugniaud PY, Bourelly L, Rabilloud M, Boutitie F, Douplat M, Tassa O, Haesebaert J, Termoz A, Schott AM. Evaluation of a training program for emergency medical service physician dispatchers to reduce emergency departments visits. J Am Geriatr Soc. 2023 Feb;71(2):484-495. doi: 10.1111/jgs.18101. Epub 2022 Nov 1.

  PMID: 36317929 DERIVED

MeSH Terms

Conditions

Emergencies

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Design

• Study Type: observational
• Observational Model: OTHER
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: February 16, 2016
• First Posted: March 18, 2016
• Study Start: January 1, 2016
• Primary Completion: August 1, 2017
• Study Completion: August 1, 2017
• Last Updated: February 26, 2018

Record last verified: 2018-02

Data Sharing

• IPD Sharing: Will not share

Locations

FR (1)