Patient flow and safety after implementing a community paramedicine service: a quasi-experimental study

Community paramedicine services (CPSs) may alleviate the increasing pressure on emergency medical services (EMSs) but lack the capacity for patient transport. The study aims to determine whether a municipality implementing the CPS between periods (CPS_REGION) compared with a control municipality (CTR_REGION) served by EMS only affected patient flow and safety in a rural Norwegian setting.

A quasi-experimental study evaluating patient flow and safety before and after the introduction of CPS in one of two rural municipalities.

Two rural Norwegian municipalities that were served by EMS from nearby municipalities before the study started.

Before and after the introduction of CPS, a total of 604 and 650 patients, respectively, were included in CPS_REGION, and 367 and 408 patients, respectively, in CTR_REGION.

CPS was introduced in CPS_REGION between the two data collection periods, whereas CTR_REGION continued to be served by EMS.

The outcome of patient flow was assessed by the number of admissions to nearby hospitals, the number of patient contacts and the location for delivery and treatment. The outcome for safety was assessed as the need for medical recontact within 7 days and 30-day mortality.

Hospital admission rates increased over the two study periods, being insignificant in CPS_REGION (+4.7%, p=0.373) and significant in CTR_REGION (+23.2%, p<0.001). EMS recontacts within 7 days and 30-day mortality rates were both unchanged (p≥0.119).

Introducing CPS resulted in fewer hospital admissions, with more patients being treated locally. No safety concerns with respect to medical recontacts and 30-day mortality were observed. We conclude that CPS can alter patient flow towards more local treatment without compromising safety.