This article is right and wrong on many levels.
Right:
Most assisted-living patients who fall do not need to be treated in the ED.
"One patient had palliative care initiated" – why
not others?
Wrong:
There was no discussion about the patient being able to refuse transport to the ED.
If patients were receiving palliative care before they fell, more attention would have been given to what their wishes were.
This study was contingent on:
- Paramedic's willingness to
consider a non-transport protocol.
(paramedics are like taxi drivers – they get paid by transporting people)
- Primary doctor being available for phone calls from paramedics.
(primary doctors rarely return phone calls to emergency departments)
How to Right the Wrong?
If reasonable, the assisted-living nurse makes an assessment of the fallen patient and calls the palliative nurse before calling 911. Help lifting may be necessary, but transport to the ED has been shown to be often unnecessary by this study. If
patients receive palliative care, they’re more in charge of the situation and less like pawns of defensive medicine. The study needs to conclude that more chronically-ill patient needs palliative care services.
