British Columbia emergency health services assess, see treat and refer palliative clinical pathway

Background/Research Objectives Paramedic services have experienced a steadily increasing demand from palliative patients accessing 911 during times of acute crisis, and not wishing subsequent conveyance to ED. Early data indicates that many of these patients are NOT already connected to palliative care teams.

To address this demand and to connect patients to care, BCEHS introduced the Assess, See, Treat and Refer (ASTAR)-Palliative Clinical Pathway. Objectives are to reduce patient conveyance to ED, reduce hospitalizations and improve patient care through referral after non-conveyance.

Intervention Paramedic activation of the ASTaR Palliative Clinical Pathway results in referral of non-conveyed palliative patients to local Home and Community Care teams and BCEHS paramedics. The referral occurs within 1-6 hours of paramedic contact and follow up occurs over the next 24-48 hours by telephone. This referral action provides safe, effective, patient-centred care for non-conveyed patients, and also fills a gap for connecting patients to local palliative care teams.

Impact A retrospective case review of 183 cases was conducted. Symptom improvement was achieved in 70% of cases, the ED non-conveyance rate was 19%, and the time on task when palliative patients were treated at home and not conveyed was 37% less (52 minutes) than if palliative patients were transported (82 minutes). All 183 patients were connected to either the local home and community care team or BCEHS Rural Advanced Care Community Paramedics (RACCP).

Lessons Learned Palliative patients frequently call 911 for help during acute crisis events and many of these patients do not wish conveyance to ED. The introduction of the ASTaR palliative clinical pathway provided safety netting and referral to appropriate care teams.