Emergency Geriatric Care Clinical Trial
— REGESAOfficial title:
Tools Development for Geriatric Emergency Regulation at the Emergency Service Centre, in the Rhône Area
| Verified date | February 2018 |
| Source | Hospices Civils de Lyon |
| Contact | n/a |
| Is FDA regulated | No |
| Health authority | |
| Study type | Observational |
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.
| Status | Completed |
| Enrollment | 2279 |
| Est. completion date | August 2017 |
| Est. primary completion date | August 2017 |
| Accepts healthy volunteers | No |
| Gender | All |
| Age group | 75 Years and older |
| Eligibility |
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 Exclusion Criteria: - Patient calling for vital emergency (hospital regulation) - Patient calling for inter-hospital transport |
| Country | Name | City | State |
|---|---|---|---|
| France | Service Gériatrie - Hôpital Edouard Herriot, Hospices Civils de Lyon | Lyon |
| Lead Sponsor | Collaborator |
|---|---|
| Hospices Civils de Lyon |
France,
| Type | Measure | Description | Time frame | Safety issue |
|---|---|---|---|---|
| Primary | Proportion of patients sent to an emergency department | 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. | 24 hours after patient's call | |
| Secondary | Duration of the hospital stay in emergency department | 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. | 7 days after patient's call | |
| Secondary | Occurence of non-programmed hospitalization in emergency department | 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 | 7 days after patient's call | |
| Secondary | Geriatric channel utilisation rate | 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 | 24 hours after patient's call | |
| Secondary | Training course feasibility | 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) | 24 hours after patient's call | |
| Secondary | Medical cost for patient | 7 days after patient's call | ||
| Secondary | Non medical cost for patient | 7 days after patient's call | ||
| Secondary | Training course cost | 7 days after patient's call |