Bridging Hospice and Prehospital Care: Why Emergency Medical Services Is Called

Most (84%-96%) emergency medical services (EMS) clinicians report caring for hospice-enrolled patients. However, the reasons these patients, their caregivers, or hospice teams engage EMS are poorly understood. Our objective was to characterize the frequency, circumstances, and reasons for EMS encounters involving hospice-enrolled patients.

This was a retrospective cohort study of prehospital patient encounters from 5/1/2018 to 12/31/2023 within a large, multistate Midwestern EMS agency encompassing 15 ground and 3 air sites. Narratives from prehospital electronic patient care records (ePCR) were searched for the term “hospice”. Encounters in which review of the narrative indicated the patient was enrolled in hospice and in which EMS had contact with the patient were included. A qualitative content analysis was undertaken and a mixed inductive-deductive codebook was iteratively developed. EMS run narratives were coded by four members of the research team to characterize the themes and subthemes of EMS engagement.

5326 patient encounters were identified, among which 4421 met inclusion criteria, representing 79 encounters per month. Median age was 80.1 years (IQR: 69.7-88.7) and 49.8% were male. A majority of encounters were for transportation (60.3%, n=2666), most often at hospital discharge to an assisted living/hospice/nursing facility (37.4%, n=997) or private residence (26.4%, n=705). Management of acute medical needs (35.9%, n=1587) was the second most common theme, with falls/lift assists (46.0%, n=730), desire for further evaluation (24.5%, n=389), and dyspnea (4.7%, n=75) the most frequent subthemes. Forty-one percent (n=650) of patients with acute medical needs were treated in place. Less than half of encounters for acute medical needs included documentation that hospice was contacted prior to or during EMS response (49.2%, n=781). Cardiopulmonary resuscitation and advanced airway utilization were rare (n=39 unique encounters, 0.9%).

To the authors' knowledge, this is the largest study of EMS engagement with hospice-enrolled patients. EMS clinicians frequently care for hospice-enrolled patients, with significant resources directed to non-emergent transports and falls/lift-assists. This suggests an opportunity for improved coordination between EMS and hospice agencies to align resources with patient needs.