Tools Development for Geriatric Emergency Regulation

Completed

• Conditions: Emergency Geriatric Care

• Registration Number: NCT02712450
• Lead Sponsor: Hospices Civils de Lyon

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.

Detailed Description

Not available

Basic Information
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Recruitment & Eligibility
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Study & Design
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Trial Locations

Study Timeline

• Study Start: 2016-01
• Study First Submitted: 2016-02-16
• Study First Submitted QC: 2016-03-14
• Study First Posted: 2016-03-18
• Primary Completion: 2017-08
• Study Completion: 2017-08
• Status Verified: 2018-02
• Last Update Submitted: 2018-02-23
• Last Update Posted: 2018-02-26

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 2279

Inclusion Criteria

• 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

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Exclusion Criteria

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

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Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Proportion of patients sent to an emergency department	24 hours after patient's call	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.

Secondary Outcome Measures

Name	Time	Method
Duration of the hospital stay in emergency department	7 days after patient's call	The training course efficiency on hospital stay duration will be assessed by evaluating the duration of the hospital stay in emergency department, after regulating doctor decision.
Occurence of non-programmed hospitalization in emergency department	7 days after patient's call	The training course efficiency on non-programmed hospitalization in emergency department will be assessed by evaluating the occurence of these type of hospitalization one week after call regulation
Geriatric channel utilisation rate	24 hours after patient's call	Training course efficiency on the geriatric channel utilization by regulating doctors will be assessed using multiple parameters : geriatric hotline use, intra-hospital geriatric mobile team mobilisation, extra-hospital geriatric mobile team mobilisation, direct hospitalization in geriatric department
Training course cost	7 days after patient's call
Training course feasibility	24 hours after patient's call	Training course feasibility will be assessed using multiple parameters : regulation call duration, regulating doctor orientation respect, contact between regulating doctor and physician (GP, geriatric doctor, emergency doctor, geriatric channel)
Medical cost for patient	7 days after patient's call
Non medical cost for patient	7 days after patient's call

Trial Locations

Locations (1)

Service Gériatrie - Hôpital Edouard Herriot, Hospices Civils de Lyon; 🇫🇷 Lyon, France