Paramedics hope to help palliative patients stay at home longer

A new collaboration between paramedics and extramural nurses is expected to help palliative care patients in New Brunswick stay at home, and out of the emergency room.

Susan Dugas, project co-leader for Ambulance New Brunswick, said the partnership with the extramural program will change the way paramedics respond to 911 calls from palliative patients and their families.

In the past, paramedics had no choice but to transport patients directly to hospital.

"There was no option to leave those patients at home unless they refused transportation. So our focus is on providing care at home instead." she said. "Most patients would prefer to remain at home."

In 2019 Ambulance New Brunswick responded to about 930 calls from extramural palliative patients, according to Dugas. Of those calls, 90 per cent of patients were immediately transferred to emergency rooms.

"The unique thing about our project is [paramedics] will reach out to our extramural health-care professionals, usually a registered nurse who knows the patient best, and together will collaboratively develop a care plan to address the current symptom crisis in the home," Dugas said. 

A similar model has been implemented in Nova Scotia, Prince Edward Island and Alberta, and Dugas said paramedics are spending less time treating patients at home than they would transporting them to hospital.

Support of hospice

Dugas explained that's because ambulances often experience long "offload delays" at hospitals when emergency rooms are crowded and beds aren't available.

A brochure about the new approach said of the benefits: "Patients experienced fewer unnecessary emergency department visits and hospitalizations along with reduced time on task for paramedics, thereby improving system efficiency."

Tradina Meadows-Forgeron, executive director of Hospice Southeast New Brunswick, is excited about the the program and supports anything that helps palliative patients stay at home as long as possible.

"We've seen some positive results in other places and we're hoping this will be the case for New Brunswick as well," she said.

Meadows-Forgeron believes the support from paramedics will also help caregivers who want to stay at home with their loved one as long as possible.

Hospice Southeast New Brunswick has plans to begin construction on a 10-bed hospice in Moncton in the spring, and Meadows-Forgeron expects the new approach by paramedics will complement their new residential service.

"Most palliative patients are [in hospice] two to three weeks, so if they're able to stay in their home longer, that's what we fully support."

The province's medical society also supports the idea.  Its president, Dr, Chris Goodyear, said in a statement the plan "is a positive step toward creating a better experience for patients and their families during a difficult time."

"In addition, New Brunswick's hospitals and emergency departments are often operating beyond capacity; enhancing home care options for New Brunswickers can help reduce wait times in hospitals," said Goodyear.

The change in the role of paramedics was suggested when the provincial government announced its controversial agreement that saw Medavie Health Services New Brunswick take over management of extramural services.

• New Brunswick privatizes management of extramural nursing and Tele-Care

Medavie Health Services already operated Ambulance New Brunswick and the addition of the home health-care program and 811 health advice line came into effect on Jan. 1, 2018.

Dugas said all of New Brunswick's nearly 1000 paramedics have completed a two-day training course and the new collaborative program is expected to be implemented in February.