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Randomized Controlled Trial of a Prehospital Decision System by Emergency Medical Services to Ensure Optimal Treatment for Older Adults in Sweden
Author(s) -
Vicente Veronica,
Svensson Leif,
Wireklint Sundström Birgitta,
Sjöstrand Fredrik,
Castren Maaret
Publication year - 2014
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.12888
Subject(s) - medicine , randomized controlled trial , emergency medical services , intervention (counseling) , emergency department , clinical endpoint , medical emergency , confidence interval , emergency medicine , psychological intervention , nursing , surgery
Objectives To evaluate the feasibility and appropriateness of a prehospital system allowing ambulance nurses to transport older adults directly to geriatric care at a community‐based hospital ( CH ) or to an emergency department ( ED ). Design Randomized controlled trial. Setting Emergency medical services in Stockholm, Sweden. Participants Older adults who called the emergency number were randomized to an intervention group (n = 410) or a control group (n = 396). Intervention The dispatcher randomized the individuals. Those randomized to the intervention group were transported to several alternative destinations decided by a trained nurse performing a comprehensive assessment, using the new prehospital system. Those randomized to the control group were transported to the ED . Measurements Primary endpoint: number of individuals triaged directly to a CH (feasibility). Secondary endpoint: number of subsequent transfers (appropriateness) from CH to ED within 24 hours after initial admission. Results After exclusion and crossover, the control group consisted of 217 and the intervention group of 449 older adults. The nurse sent 20% of the intervention group (90/449) (95% confidence interval ( CI ) = 16.6–24.0) directly to the CH when using the prehospital system. Six of those individuals (6.7%) (95% CI = 3.1–13.8) were subsequently transferred from the CH to the ED . Overall, the nurse appropriately triaged 93.3% of the participants (84/90) and transferred them to the CH , avoiding an ED visit. Conclusion Ambulance nurses are able to send older adults to an alternative healthcare facility with the help of a prehospital decision support system. In this geographical setting, this appears to be a promising method to optimize resources and improve emergency care of elderly adults.