Geriatrician telephone support for emergency medical dispatchers: safe alternatives for older patients at high risk of short-term emergency department visits.

aimFor older patients at presumed high risk of short-term emergency department visits but without immediate hospital needs, we aim to describe a system that provides geriatrician telephone support to emergency medical dispatchers, offering a safe alternative to emergency department referral.

findingsProviding geriatrician telephone support to emergency medical dispatchers could offer an alternative to referring certain older patients at presumed high risk of a short-term emergency department visit. Among older patients for whom an emergency department referral was not initially recommended, some experienced early unplanned hospital visits, highlighting the need to develop and strengthen reactive alternatives to emergency department referral. MESSAGE: Collaboration between emergency medical dispatchers and on-phone geriatricians could provide a safe alternative to emergency department referrals for older patients at presumed high risk of short-term ED visits. PURPOSE: To describe a system enabling Emergency Medical Dispatchers (EMD) to access direct geriatrician telephone support (SCAS: Senior Care Access System) with the purpose of providing alternatives to Emergency Department (ED) referral for older patients at presumed high risk of short-term ED visits.

methodsThis prospective study was conducted at the EMD of Toulouse University Hospital. EMD could contact the SCAS for patients aged 75 or older who were presumed to be at high risk of a short-term ED visit but did not require an immediate ED referral. The primary outcome was the alternative to ED referral decided by the SCAS, which included telephone advice, geriatric consultation, geriatric day hospital admission, admission to post-acute care and rehabilitation, or direct admission to an acute geriatric unit. Secondary outcomes were i) alternative follow-up destinations and ii) early unplanned hospital visits (ED visit or unplanned hospital admission within 7 days following the SCAS call).

resultsA total of 364 patients were included between September 1, 2023 and February 28, 2025. The mean age of the patients was 87.5 years (± 8.3), and 40.1% were male. The primary reason for the call was altered general health status (30.8%), followed by falls (17.9%). An alternative to ED referral was proposed for 287/364 patients (78.8%). Among the 117 patients for whom the SCAS decided no ED referral or admission to an acute geriatric unit, 32 (27.4%) patients experienced an early unplanned hospital visit within a median delay of 3 days.

conclusionOur study suggests that geriatrician telephone support for EMD could offer an alternative to ED referral for older patients with presumed high risk of short-term ED visit.