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Which patients should be transported to the emergency department? A perpetual prehospital dilemma
Author(s) -
Tohira Hideo,
Fatovich Daniel,
Williams Teresa A,
Bremner Alexandra,
Arendts Glenn,
Rogers Ian R,
Celenza Antonio,
Mountain David,
Cameron Peter,
Sprivulis Peter,
Ahern Tony,
Finn Judith
Publication year - 2016
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/1742-6723.12662
Subject(s) - medicine , emergency department , emergency medicine , medical emergency , community hospital , triage , metropolitan area , emergency medical services , nursing , pathology
Objective To examine the ability of paramedics to identify patients who could be managed in the community and to identify predictors that could be used to accurately identify patients who should be transported to EDs. Methods Lower acuity patients who were assessed by paramedics in the Perth metropolitan area in 2013 were studied. Paramedics prospectively indicated on the patient care record if they considered that the patient could be treated in the community. The paramedic decisions were compared with actual disposition from the ED (discharge and admission), and the occurrence of subsequent events (ambulance request, ED visit, admission and death) for discharged patients at the scene was investigated. Decision tree analysis was used to identify predictors that were associated with hospital admission. Results In total, 57 183 patients were transported to the ED, and 10 204 patients were discharged at the scene by paramedics. Paramedics identified 2717 patients who could potentially be treated in the community among those who were transported to the ED. Of these, 1455 patients (53.6%) were admitted to hospital. For patients discharged at the scene, those who were indicated as suitable for community care were more likely to experience subsequent events than those who were not. The decision tree found that two predictors (age and aetiology) were associated with hospital admission. Overall discriminative power of the decision tree was poor; the area under the receiver operating characteristic curve was 0.686. Conclusion Lower acuity patients who could be treated in the community were not accurately identified by paramedics. This process requires further evaluation.