Evaluation of an emergency medical services-based social services referral program for elderly patients.
OBJECTIVE
To describe the preliminary experience of an emergency medical services (EMS)-based follow-up program providing elderly patients access to community-based social services.


METHODS
This was a retrospective, case series report. Inclusion criteria were adults aged 60 years and older requesting EMS for fall or lift assist; against medical advice (AMA) refusal of transport for a medical complaint; any social service or home care needs; request for nonmedical transportation; multiple prior EMS visits; or cases of elder abuse or neglect. Patients were identified either by paramedics at the time of the call or an EMS physician during routine chart review of "no-transport" calls. Patients were then contacted and offered referral follow-up with a social services worker. Data were collected for age, gender, presence of established social services, referral strategy, complaint type, referral acceptance rate, and follow-up plan.


RESULTS
Seventy patients were referred over eight months. Paramedics provided 33% of referrals (23/70) as well as a significantly higher number of social service-related complaints (48% vs. 15%, p = 0.005). Follow-up from a fall occurred more often after EMS physician chart review (53% vs. 30%, p = 0.07). Rates of established social services were similar for patients who accepted and those who declined follow-up (89% vs. 90%, p = 0.95) and between patients who were referred by paramedics and those who were referred by EMS physicians (93% vs. 90%, p = 0.72). Paramedic referral was associated with a significantly higher rate of acceptance (94% vs. 28%, p < 0.001).


CONCLUSIONS
EMS provides an invaluable opportunity to connect the elderly with social services at the time of contact. In this study, paramedics appeared to refer more social service-related complaints compared with other categories such as fall assistance. This highlights a difference in perception of social service needs among paramedics and represents an area for further training and education.
Kue
Ricky
R
Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland 21209, USA. mdemtp@yahoo.com
Ramstrom
Edward
E
Weisberg
Stacy
S
Restuccia
Marc
M
D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D012017:Referral and Consultation / Q000458:organization & administration*; D012189:Retrospective Studies