Characteristics and paramedic management of patients enrolled in a novel assess, see, treat and refer palliative care clinical pathway: A retrospective descriptive cohort study

Abstract

Introduction: Patients with palliative care needs seek support from paramedics in instances of unexpected worsening of symptoms associated with their primary diagnosis, but often do not desire conveyance to an emergency department. Despite this, up to one-quarter of patients with palliative care needs will experience an avoidable admission to the emergency department. British Columbia Emergency Health Services, in collaboration with Canadian Virtual Hospice and regional health authorities, developed the Palliative Care Assess, See, Treat and Refer (ASTaR) Clinical Pathway, with palliative clinical practice guidelines and education to support paramedics minimising avoidable admissions to emergency departments. Aim: To describe the paramedic management of patients enrolled in the palliative care ASTaR clinical pathway, supported by paramedic-specific education and clinical practice guidelines. Methods: This study was a retrospective descriptive cohort study of the first 100 patients enrolled by paramedics in the palliative care ASTaR clinical pathway following its introduction in October, 2019. Results: The median age of patients was 78 years (IQR 70–88), they were more often male (n = 58) and in a private residence at the time of 911 call (n = 91). Calls for assistance were in the work week (n = 73), but often out of business hours (n = 61). Primary care paramedics provided the majority of care (n = 64), most frequently contacting paramedic specialists for clinical advice (n = 32, 47%). The most common patient complaints were dyspnoea (n = 25), altered conscious state (n = 16), mobility assistance (n = 14), and pain (n = 13), with pharmaceutical intervention required in less than half of cases. Conclusion: Paramedics continue to play a critical role in supporting patients with palliative care needs, particularly during out-of-hours periods. When supported by robust clinical practice guidelines and integrated systems of care, this cohort study demonstrates that paramedics may be able to manage the requirements of patients with palliative care needs and their family, friends, and carers, beyond clinical care and conveyance.