Mobile Medical Teams are Often Over-Qualified

Abstract

Background and Importance: Emergency department (ED) staff in Belgium is simultaneously involved in patient care in the ED and in prehospital interventions as part of a Mobile Medical Team (MMT) or a Paramedic Intervention Team (PIT). There is a growing concern that the MMT is often over-qualified for the prehospital interventions they are dispatched to, while their absence from the ED results in insufficient human resources there. Objective: The current study aims to investigate whether this perception is correct in the EDs of two different regions, while also examining the differences between a two-tiered (2T) and a three-tiered (3T) Emergency Medical Services (EMS) region. Methods: A specially developed and pre-tested registration form was completed by physicians and nurses before and after each MMT intervention. The form included information on the composition of the MMT, the perceived need for MMT intervention pre-departure from the ED, the subjective appreciation of the need for the MMT after an intervention, and the therapeutic intervention(s) performed, in order to obtain a more objective appreciation of the actual need for an MMT. Data from a 2T and a 3T region were analyzed to rate the appropriateness of the interventions. Results: Although the 2T and 3T regions showed differences regarding MMT composition, dispatching, and logistics, the outcome of the study was identical in both regions. Before the intervention, physicians and nurses estimated that the MMT intervention would not be necessary in 37.7% of cases. However, following the intervention, it was subjectively deemed unnecessary in 65.7% of cases. Based on therapeutic interventions performed, the MMT was viewed as being over-qualified for carrying these out in 85.6% of cases. Post-intervention, the initial prediction that the MMT was over-qualified for the call was confirmed by the same physicians and nurses in 87.6% of cases, whilst their prediction was correct in 92.8% of cases in terms of the intervention that was carried out. Conclusion: In two different Belgian regions, the MMT is over-qualified in a vast majority of interventions. Physicians and nurses within the MMT can generally already predict that the MMT is over-qualified when leaving the ED. These findings suggest that there may be significant opportunities to improve the efficacy of human resources in the ED once there are less interventions carried out by an over-qualified MMT.

Emergency physicians’ and nurses’ perception on the adequacy of emergency calls for nursing home residents: a non-interventional prospective study

“…EMS teams in Belgium are often overqualified for the NH interventions they are sent to. One should reflect on downscaling the tier for NH interventions ( 8 , 23 ).…”

“…Is a low-threshold activation of the highest (physician based) tier of EMS appropriate for emergency calls in NHs, and are hospital admissions the best available medical care? ( 8 , 23 ) or should health care systems optimize their use and deployment of resources for NHRs? When reviewing the literature, a proportion of these interventions and transfers may be preventable and considered inappropriate by prehospital emergency medical personnel (with inappropriate emergency department transfers accounting for 4–55% of all EMS calls), soliciting the need for further investigation of the appropriateness of hospital transfers in this patient group ( 5 , 24–26 ).…”

Data_Sheet_2.docx

“…EMS teams in Belgium are often overqualified for the NH interventions they are sent to. One should reflect on downscaling the tier for NH interventions (8,23).…”

“…Is a low-threshold activation of the highest (physician based) tier of EMS appropriate for emergency calls in NHs, and are hospital admissions the best available medical care? (8,23) or should health care systems optimize their use and deployment of resources for NHRs? When reviewing the literature, a proportion of these interventions and transfers may be preventable and considered inappropriate by prehospital emergency medical personnel (with inappropriate emergency department transfers accounting for 4-55% of all EMS calls), soliciting the need for further investigation of the appropriateness of hospital transfers in this patient group (5,(24)(25)(26).…”