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Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

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1. Increased collaboration between emergency medical services (EMS) and primary care physicians could decrease frequency of unnecessary transportation to the emergency department (ED) for fallen residents of assisted living facilities.

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2. For study participants, the protocol recommended non-transport for over half of the seniors’ falls.

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Evidence Rating Level: 2 (Good)

Study Rundown:

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It is common for residents of assisted living facilities to fall. However, protocols frequently result in residents being transported to the ED even when the patient is not seriously ill or injured, resulting in unnecessary use of resources that could be allocated in other manners. This study evaluated whether unnecessary transport could be avoided. Specifically, they developed a protocol that aimed to reduce unnecessary transport of seniors that had ground-level falls in assisted living facilities. One of the key elements of the protocol was its increased emphasis on collaboration between EMS and the patients’ primary care physicians. In general, it was observed that improved collaboration resulted in less unnecessary transport. This study had several limitations. First, the resources required for this program are not available in all facilities, thereby limiting the number of locations in which this protocol can be run. Furthermore, there was a degree of selection bias, as the authors used the Medical Priority Dispatch System to select patients. This system excluded patients with specific medical conditions before the patients became eligible for the study.

In-Depth [prospective cohort]:

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The protocol used in this study was first evaluated using retrospective data, which suggested that the program may reduce unnecessary transport by 50 per cent. The primary goal was to prospectively evaluate the protocol to assess its efficacy in reducing unnecessary transport of fallen seniors from assisted living facilities. Descriptive statistics were used to analyze data and classify patients based on whether they received appropriate care. In total, 953 out of 1472 eligible residents consented to participate in the study. Of these residents, 359 had 840 falls in 43 months. Based on the protocol, transport was not required in 553 of the falls. For the 11 patients that had time-sensitive conditions, the paramedic discussed 9 of the 11 patients with their primary care physicians. Overall, the authors found that for residents for whom non-transport was recommended by the protocol, 99.3% of patients [95% CI, 98.2% to 99.8%] received appropriate care.

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