Patient satisfaction and outcome using emergency care practitioners in New Zealand (Two Papers)
Research For Life
Reports of research work funded by grants prior to 2012
Department of Surgery and Anaesthesia
This grant was intended to allow extended care paramedics (ECPs) in the Kapiti District to record their clinical notes on rugged notebook computers using software designed for this purpose. The clinical information was then downloaded to form a database of ECP cases. A retrospective search through the hospital and GP electronic record systems was then undertaken to identify patients who attended hospital or consulted their GP after being treated by an ECP.
A patient satisfaction survey was undertaken in the Kapiti District of the Wellington Region to ascertain patients’ experience and opinions of New Zealand’s first extended care paramedic (ECP) service before consideration is given to extending it to other locations within the region. Patient outcomes were also analysed for 1 week following ECP care.
One hundred patients, 50 attended by ECPs and 50 by standard emergency ambulance service paramedics, were interviewed by an independent assessor, either in person or by phone according to patient preference. The questionnaire was aimed at comparing the experience of both groups of patients, dividing them into those treated at home and those transferred to the ED. ED and general practice records were then reviewed to determine whether the ECP-treated patients attended either facility within 7 days and why.
Patients were very satisfied with their experience of both groups of paramedics but expressed a clear desire to be treated at home if possible. Of the 50 ECP-treated patients, 11 were transferred directly to the ED. Only one clinical complication arose over the next 7 days in those treated in the community: a seizure in a patient with refractory epilepsy.
The avoidance of unnecessary transfers to hospital is beneficial to patients, the ambulance service and the ED. This study demonstrates that patients are very satisfied with their assessment and treatment by ECPs, endorsing the proposal that the scheme should be extended across the Wellington Region, and perhaps New Zealand.
The first extended care paramedic (ECP) model of care in New Zealand was introduced in the Kapiti region, north of Wellington in 2009. The ECP model aimed to increase the proportion of patients presenting to the ambulance service who could be treated in the community. This study evaluated the first 1000 patients seen by ECPs.
The first 1000 presentations attended by ECPs were examined to determine the proportions of patients transported to the emergency department (ED) and treated in the community. For patients treated in the community we determined the number presenting to ED within 7 days of ECP attendance.
A total of 797 patients (mean age 62 years) had 1000 clinical presentations. In 59% the patient was treated either at home or in the local community, with 40% transported to ED. Within the same region and time period 74% of patients attended by standard paramedics were transported to ED. The rate of ECP transport to ED differed significantly by clinical condition (p=0.0001), with 71% of cardiac presentations versus 19% of patient with spinal problems taken to ED. In 31 cases (5%) where the patient had been managed in the community there was an acute ED presentation within 7 days.
We observed that ECP’s have significant potential to reduce hospital ED attendances by treating more patients in the community, and this is associated with a low rate of subsequent ED presentations. Prioritisation of dispatch of ECPs to particular types of patients may be useful in maximising this reduction.
Data for a third study is being analysed at the moment. This is a randomised controlled trial of ECP care versus standard paramedic care. It is anticipated that this paper will be submitted for publication in the second half of 2012.