Using vignettes to assess the accuracy and rationale of paramedic decisions on conveyance to the emergency department

Miles, Jamie; Coster, Joanne; Jacques, Richard

doi:10.29045/14784726.2019.06.4.1.6

Cited by 6 publications

(9 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…missed learning opportunities). 6 Miles 2019 [ 49 ] UK n = 143 Surveys with paramedic using quantitative and qualitative assessment of 6 patient vignettes To: i. examine if paramedics can accurately identify the most clinically necessary destination ii. .understand what contributes to decision making.…”

Section: Resultsmentioning

confidence: 99%

“…The main barriers identified by paramedics to successful implementation were training, organisational support and process. First, the absence of training and knowledge on referral triage and processes [ 13 , 43 , 45 , 47 , 48 , 52 ] often manifested as a lack of confidence in both themselves and the system [ 13 , 48 ], with some paramedics expressing concerns about being held accountable or facing legal action for under triaging patients [ 47 , 49 ]. Next, there were concerns that the absence of a mandate from their organisation led to a lack of responsibility to refer and, thus, underuse of the scheme [ 43 , 45 ].…”

Section: Resultsmentioning

confidence: 99%

“…Conversely, nearly all relevant studies failed to formally assess whether the schemes are safe and instead, considered accuracy of conveyance decisions (e.g. between ambulance clinicians and expert medical consultants) [ 31 , 35 , 36 , 49 ] or rates of secondary contact [ 25 , 28 – 30 , 38 , 39 , 41 ] as proxies for patient safety. While accuracy of decision making may inform future outcomes, it is important to consider both short and long-term patient safety.…”

Section: Discussionmentioning

confidence: 99%

“…with non-ED conveyance alternatives) compared to a control group, reporting there was no difference in secondary transport within 48 h (7.9% vs 8.0%) [ 28 ]. Failure of studies to appropriately consider the impact on the whole system has previously been highlighted [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

“…Finally, it is important to identify an acceptable under triage rate in non-ED conveyance situations [ 10 ]. High sensitivity of tools suggest that ambulance clinicians are able to accurately assess who needs to go to ED, while the lower specificity indicates that they are less able to identify who may benefit from an alternative care route [ 31 , 35 , 49 ]. Over conveyance to ED is preferable to a model that regularly under triages individuals to lower levels of care than is required, and as such, triage tools for non-ED alternatives may necessitate a high-sensitivity, low specificity approach [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

See 4 more Smart Citations

Alternatives to direct emergency department conveyance of ambulance patients: a scoping review of the evidence

Blodgett

Robertson

Pennington

et al. 2021

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

Background The role of ambulance services is shifting, due in part to more intermediate, non-urgent patients who do not require direct emergency department conveyance, yet who cannot be safely left at home alone. Evidence surrounding the safety, effectiveness and efficiency of alternate care routes is not well known. Methods This scoping review sought to identify all studies that examined alternate routes of care for the non-urgent “intermediate” patient, as triaged on scene. Search terms for the sample (ambulances, paramedics, etc.) and intervention (e.g. referrals, alternate care route, non-conveyance) were combined. Articles were systematically searched using four databases and grey literature sources (February 2020). Independent researchers screened title-abstract and full text stages. Results Of 16,037 records, 41 examined alternate routes of care after triage by the on-scene paramedic. Eighteen articles considered quantitative patient data, 12 studies provided qualitative perspectives while 11 were consensus or opinion-based articles. The benefits of alternative schemes are well-recognised by patients, paramedics and stakeholders and there is supporting evidence for a positive impact on patient-centered care and operational efficiency. Challenges to successful use of schemes included: patient safety resulting from incorrect triage decisions, inadequate training, lack of formal partnerships between ambulance and supporting services, and insufficient evidence to support safe implementation or continued use. Studies often inaccurately defined success using proxies for patient safety (e.g. decision comparisons, rates of secondary contact). Finally, patients expressed willingness for such schemes but their preference must be better understood. Conclusions This broad summary offers initial support for alternate routes of care for intermediate, non-urgent patients. Even so, most studies lacked methodologically rigorous evidence and failed to evaluate safe patient outcomes. Some remedies appear to be available such as formal triage pathways, targeted training and organisational support, however there is an urgent need for more research and dissemination in this area.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Alternatives to direct emergency department conveyance of ambulance patients: a scoping review of the evidence

Blodgett

Robertson

Pennington

et al. 2021

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

show abstract

Characteristics and Outcomes of Patients Referred to a General Practitioner by Victorian Paramedics

Delardes,

Nehme,

Bowles

et al. 2024

Prehospital Emergency Care

View full text Add to dashboard Cite

Rethinking non-urgent EMS conveyance to ED during night-time - a pilot study in Southwest Finland

Kasvi,

Iirola,

Nordquist

2023

BMC Emerg Med

View full text Add to dashboard Cite

Background The amount of emergency medical service missions has increased internationally in recent years, and emergency departments are overcrowded globally. Previous evidence has shown that patients arriving at the emergency department during nighttime (20 − 08) have to wait longer, are more likely to leave without being seen, and often have non-urgent conditions compared to patients arriving during the day. The objective of this pilot study was to examine what kind of patient groups are conveyed as non-urgent to the hospital by emergency medical service during nighttime and what kind of diagnostic tests and medical interventions those patients receive before morning to identify patient groups that could be non-conveyed or directed to alternative points of care. Methods This was a retrospective register study where the information of patients conveyed to university hospital during nighttime (20 − 08) were analyzed. Frequencies of the dispatch codes presenting complaints, medical treatments, and diagnostic tests were calculated. Age significance (under/over 70 years) was also tested. Results 73.5% of the patients received neither medical treatment nor had diagnostic tests taken before morning. Most of these were patients with mental disorder(s), hip pain/complaint, or laceration/cut. Almost half of the patients with abdominal pain or fever had laboratory tests taken. Patients over 70 years old received more medications and had more diagnostic tests taken than younger patients. Conclusions Some of the low-acuity patients could be non-conveyed or referred to alternative pathways of care to avoid impolitic use of emergency medical service and to reduce the workload of emergency departments. Further research is needed to ensure patient safety for patients who are not conveyed at night.

show abstract

Using vignettes to assess the accuracy and rationale of paramedic decisions on conveyance to the emergency department

Cited by 6 publications

References 14 publications

Alternatives to direct emergency department conveyance of ambulance patients: a scoping review of the evidence

Alternatives to direct emergency department conveyance of ambulance patients: a scoping review of the evidence

Characteristics and Outcomes of Patients Referred to a General Practitioner by Victorian Paramedics

Rethinking non-urgent EMS conveyance to ED during night-time - a pilot study in Southwest Finland

Contact Info

Product

Resources

About