RESUMO
OBJECTIVES: This study was undertaken to evaluate the impact of paramedical hospice specialists on hospitalization of terminally-ill patients in acute medical emergencies. METHOD: In this intervention, the SAMU (French medical emergency call center) responded to requests for emergency aid at the homes of terminally-ill patients by sending to the patient's home, together with a physician and the emergency ambulance team, a team composed of a nurse and a volunteer, both trained in hospice (terminal) care . When the patient wished to stay at home, the hospice team remained to support the patient and family and to provide comfort care until the crisis situation stabilized. This before-and-after study compares SAMU calls during the first year of the intervention to those in the preceding year. RESULTS: During the intervention period, 14% of patients were hospitalized compared with 48% during the reference year (p<0.0001), for a relative risk of hospitalization of 0.29. The emergency hospice team was considered to be not only complementary but also essential in emergency medical situations for patients receiving palliative care at home. Interaction with existing services did not present problems. Families benefited from considerable assistance in particularly difficult situations. CONCLUSION: A team of paramedical hospice specialists, acting on request of the SAMU, provides a concrete and useful response to problems of unwanted hospitalization in acute emergencies for home-based terminally ill patients. This type of organization is consistent with respect for the patient's choice to remain at home until the end of life. Prevention of unwanted hospitalization and heroic measures should undoubtedly result in cost savings more than sufficient to fund this program.
