Evaluating PreALRT Program Impact on NB Seniors

About the project

  • The increased use of emergency departments (EDs) in NB has led to ambulance "off-load delays." This means that when there are no available beds, incoming patients must wait in ambulances before they can be transferred to the hospital. This situation can have negative effects for patients and the healthcare system alike, and cause ambulance response times to be longer.
  • The Pre-hospital Alternative Low Risk Triage (Pre-ALRT) program was implemented by Ambulance New Brunswick (ANB) in 2022 with the aim of reducing ED visits for low-acuity patients calling 911. 
  • The goal of Pre-ALRT is to reduce the number of low-risk patients being transported to hospital unnecessarily by identifying non-urgent patients and informing them about alternate healthcare services.
  • The aim of this evaluation was to explore the impact of Pre-ALRT on seniors (65+) who call 911 and system-level outcomes such as 911 calls, ED visits, hospital admissions, and access to other health care services. The evaluation also sought to explore paramedics’ perceptions of the Pre-ALRT program. 
  • Administrative data from 89,759 patient contacts (55% women) was used in the evaluation. Of which 47,007 patients were in contact with the pre-ALRT program after its implementation. A subset of nontransport patients was also tracked over time (n = 7,785). Additionally, a total of 87 paramedics (64% men; 55% Anglophone) completed the staff survey and 6 paramedics participated in the focus group (all Anglophone).

Conclusions and lessons learned

  • Although the Pre-ALRT program is not having an impact on the frequency of seniors calling 911 with non-urgent health problems, these seniors are less likely to be transported to the ED following Pre-ALRT.
    • As such, the implementation of pre-ALRT is having a direct impact on decreasing the number of seniors being transported to the ED
  • As a result of the Pre-ALRT program, seniors are learning that they can access care without having to be transported to the ED by ambulance. 
  • Paramedics noted that seniors are generally more knowledgeable of community health services after engaging with Pre-ALRT.
    • However, paramedics indicated that seniors’ perceptions have begun to shift, with seniors now calling 911 for check-ups because they know Pre-ALRT non-transport is an option.
  • Paramedics noted that more education is required regarding the consistent application of the Pre-ALRT triage tools.

Recommendations

From the findings, the project recommends:

  • More robust and long-term data collection (ongoing quality assurance of the program)
  • Follow-ups with patients after they have been left home, to ensure they were able to resolve their healthcare needs

To learn more read the complete project findings (PDF 125 KB)