Referral pathway of patients aged 75 years and older after a telephone triage by the French emergency medical communication center (SAMU)

Abstract

Objectives: To map the referral pathways of elderly people after telephone calls to Emergency Medical Communication Centers (ECC) in France.

Design: Retrospective observational study.

Setting: ECC and Emergency Departments (ED) of the Rhone region in France in 2013.

Participants: Patients aged 75 years and older who called or had calls made to the ECC on 7 non-consecutive days (n = 712).

Measurements: All calls made by/for patients aged 75 and over were analyzed. Data were collected regarding geriatric assessment and patient discharge destination after admission to an ED.

Results: All 4168 calls received over the 7 days were analyzed. Of these, 692 involved the care of elderly people and were included. The median call duration was 2min59 [1min57; 4min13]. Following the call, 35% of the patients remained at home, 62% were referred to ED and 3% were directly hospitalized in intensive care units. Of the patients admitted to ED, 73% had a stable clinical condition and the main reason for admission was a fall (28%). Following ED care, 56% of patients were hospitalized and 44% returned directly home.

Conclusion: Over half the elderly patients included in this study were referred to an ED after a call to ECC. For half of them, their clinical condition was considered stable and they were discharged after the ED visit. A more appropriate assessment of clinical conditions among geriatric patients could help to improve patient triage during ECC calls, and therefore reduce ED referrals.

Keywords: Emergency medical service communication systems – elderly – triage – emergency service; Hospital-care pathway.