Palliative paramedicine: An interrupted time series analysis of pre-hospital guideline efficacy

Paramedics are increasingly involved in palliative care and often support community-based palliative care service delivery to facilitate integrated practice. However, the impact of specific palliative care guidelines on clinical practice remains unknown.

To determine the impact of an ambulance service palliative care guideline on rates of supportive medication administration and non-transport.

A retrospective cohort study of electronic patient care records from January 2014 to June 2023. Baseline characteristics were compared pre- and post-guideline introduction. Interrupted time series analysis was performed to examine guideline efficacy.

Patients of all ages receiving palliative care who were attended by paramedics in Victoria, Australia.

A total of 31,579 patients were included. The median age was 75 years (IQR = 64-84 years), and 56.4% were men. Overall, 25.8% of patients were not transported to hospital. Following guideline introduction, there were no significant trend changes in administration of supportive medications. However, the non-transport rate increased significantly per month (0.2%, p = 0.007), amounting to a 9.9% (p = 0.020) total increase by the end of the study period compared to a scenario in which the guideline had not been introduced. Subgroup analysis of patients diagnosed with 'pain' or attended after-hours also showed significant increases in non-transport (monthly increase: pain 0.3%, p = 0.003; after-hours 0.3%, p < 0.001; total increase: pain 29.7%, p < 0.001, after-hours 22.6%, p = 0.001).

Introduction of a palliative care guideline was associated with a decrease in ambulance transport to emergency departments, allowing more patients continuity of care in the community.