Sask. launches EMS treatment and referral pilot project with aim of alleviating pressure on ERs

The Saskatchewan Health Authority launched an EMS treatment and referral pilot project in Saskatoon Tuesday. 

The pilot is supposed to expand the practice of paramedics responding to 911 calls, and aims to ensure patients receive adequate and timely care while also alleviating pressures on emergency rooms in Saskatchewan, the SHA said In a press release Tuesday.

EMS workers who respond to a 911 call for a case that isn't life-threatening are now able to consult a virtual triage physician for guidance.

That doctor, who can be reached through Saskatchewan's 811 health line system, will help paramedics decide if a patient can be released at home or referred to a family doctor rather than going to the hospital emergency room, which could be over capacity. 

The program only applies to six patient scenarios: minor lacerations or abrasions without active bleeding, mild to moderate allergic reactions with dissipating symptoms, influenza-like illness, heat illness, hypoglycemia and falls.

"If the patient is reluctant in any way or has questions about staying at home as opposed to going to the emergency department, the paramedic can contact the virtual physician. The physician will talk to both the paramedic and the patient and provide reassurance if they need it," Jacquie Messer-Lepage, executive director and registrar of the Saskatchewan College of Paramedics, told CBC Tuesday.

"And if the patient still wishes to be transported, they can be. But in the case of stable patients, the idea is to keep them at home where where they're comfortable as long as they're not going to deteriorate any further."

EMS workloads

The Saskatchewan College of Paramedics was involved in the development of the pilot. Messer-Lepage said the college does not anticipate it will add any additional burden to paramedics, as they are well trained to deal with the six scenarios.

"In most cases, I think they would welcome an opportunity not to have to wait in an emergency department unless it was absolutely important to do so," said Messer-Lepage. 

The province shares the same view. 

"Paramedics have the front-line assessment skills through education and experience to safely treat specific urgent conditions in a patient's home setting," Mental Health and Addictions, Seniors, and Rural and Remote Health Minister Everett Hindley said in the press release. 

"By further empowering our front-line health-care workers with innovative and flexible options, we are able to better address patient needs and alleviate emergency room pressures."

The SHA said that only adult patients will be included in the treatment and referral pilot at this time. 

"We are looking forward to the positive impact this new process will have on patient care," Rod MacKenzie, SHA executive director of provincial services-community care, said in the release.

Packed ERs

In an interview with CBC News on Thursday, Brent Thoma, professor of emergency medicine at the University of Saskatchewan and an emergency and trauma physician in Saskatoon, said blocked access in ERs is often due to hospitals being too full. 

"When our hospitals are full, there's no room for the patients that come into the emergency department that require admission to the hospital," Thoma said.

"And so those patients that would normally be admitted and go up to the ward end up staying in the emergency department as what we call a boarded patient. And we've seen the numbers of those increasing dramatically."

In Saskatoon hospitals, Thoma frequently sees admitted patients still sitting in ER waiting rooms and standing in the hallways.  

"That means that almost all of the emergency department's resources, in terms of certainly nurses and ancillary staff, are caring for admitted patients which leaves a lot less available to have our new patients assessed and seen. And in general it blocks access to the system."

These type of system blocks are what Messer-Lepage hopes the referral pilot will help to fix. She confirmed that ER wait times are substantial.

"We have ambulances that are unable to attend to other calls because they're stuck waiting for a transfer of care. So using a program like this will actually help to alleviate some of that pressure and hopefully bring down those wait times," said Messer-Lepage.

"I think we're very optimistic that it's going to help to streamline the process through the emergency departments and channel patients who seriously need that emergency care to the right practitioners in a timely manner."

The pilot project will take place in Saskatoon over the next six to 12 months. It will include the participation of Medavie Health Services West. 

Depending on the outcomes of the pilot project, the SHA said its goal is the expand it through a phased approach to Regina and other ambulance services. Messer-Lepage said the pilot is expected to run for a total of three years.