Cheney Paul, Haddock Tiffany, Sanchez Leslie, Ernst Amy, Weiss Steven
Department of Emergency Medicine, University of New Mexico, Albuquerque, NM 87131-0001, USA.
Am J Emerg Med. 2008 Sep;26(7):750-6. doi: 10.1016/j.ajem.2007.10.019.
To evaluate compliance and safety of an emergency medical service (EMS) triage protocol that allows paramedics to transport patients directly to psychiatric emergency services.
A psychiatric patient diversion protocol was developed for our system. Protocol compliance was evaluated the following 3 ways: (1) psychiatric facility intake forms completed by mental health workers on patients transported by EMS directly to a psychiatric emergency service (PES) bypassing the ED, (2) hospital records for patients who were redirected from PES to the ED for medical evaluation, (3) retrospective analysis of ambulance charts. Study outcomes included protocol noncompliance rate, protocol failure rate, and any morbidity associated with either noncompliance or protocol failure. Data were analyzed using proportions and 95% confidence intervals (CI).
A total of 174 patients were directly transported to PES bypassing ED medical clearance. The protocol effectively screened for medical issues in 96% of cases. Protocol noncompliance occurred in 51 cases for a frequency of 29% (CI, 22%-36%). One patient in the paramedic noncompliance group required hospital admission. There was protocol failure in 5 (2.9%; 95% CI, 0.9-6.6) of the patients who fit all protocol requirements for transport to PES but required secondary transport to the ED. All were subsequently transferred back to PES. Nine patients (5.2%; CI, 2.7%-9.5%) required secondary transfer to the ED. No patient had critical or life-threatening problems.
Emergency medical service providers showed a poor level of compliance with vital sign criteria, but the protocol provided a high level of safety.
评估一项允许护理人员将患者直接转运至精神科急诊服务的紧急医疗服务（EMS）分诊方案的依从性和安全性。
为我们的系统制定了一项精神科患者分流方案。通过以下三种方式评估方案依从性：（1）心理健康工作者针对由EMS直接转运至精神科急诊服务（PES）而绕过急诊科的患者填写的精神科机构入院表格；（2）从PES转至急诊科进行医学评估的患者的医院记录；（3）对救护车图表的回顾性分析。研究结果包括方案不依从率、方案失败率以及与不依从或方案失败相关的任何发病率。使用比例和95%置信区间（CI）对数据进行分析。
共有174名患者被直接转运至PES，绕过了急诊科的医学检查。该方案在96%的病例中有效筛查出医学问题。51例出现方案不依从，频率为29%（CI，22%-36%）。护理人员不依从组中有1名患者需要住院治疗。在符合所有转运至PES方案要求但需要二次转运至急诊科的患者中，有5例（2.9%；95%CI，0.9-6.6）出现方案失败。所有患者随后均转回PES。9例患者（5.2%；CI，2.7%-9.5%）需要二次转至急诊科。没有患者出现危急或危及生命的问题。
紧急医疗服务提供者对生命体征标准的依从性较差，但该方案提供了较高的安全性。
