Clesham K, Mason S, Gray J, Walters S, Cooke V
School of Health and Related Research, University of Sheffield, Regents Court, 30 Regent Street, Sheffield S14DA, UK.
Emerg Med J. 2008 Oct;25(10):691-4. doi: 10.1136/emj.2007.054924.
Emergency medical service (EMS) staff in the UK routinely transport all emergency responses to the nearest emergency department (ED). Proposed reforms in the ambulance service mean that EMS staff will transport patients not necessarily to the nearest hospital, but to one providing facilities that the patient is judged to require. No previous UK studies have evaluated how accurately EMS staff can predict which transported patients will require admission to hospital.
To survey EMS staff regarding the appropriate use of their service and determine whether they can predict which patients will require hospital admission.
A prospective ''service evaluation'' of EMS staff transporting patients to an adult ED in the UK. Staff were asked to state whether ED attendance by emergency ambulance was appropriate and whether transported patients would be admitted or discharged from the ED.
During the study period, there were 2553 emergency transports to the ED and questionnaires were completed in 396 cases (15.5%). EMS staff predicted that 182 (46.0%) would be admitted to hospital and 214 (54.0%) would be discharged. Actual dispositions were 187 (47.2%) versus 209 (52.8%) respectively. Sensitivity of predicting admission was 71.7% (95% CI 65 to 78) and specificity was 77.0% (95% CI 71 to 81). EMS staff were significantly better at predicting admission in non-trauma cases than trauma cases (75.9% vs 57.1%, 95% CI 2.2 to 35.4).
Staff in one UK ambulance service showed reasonable accuracy when predicting the likelihood of admission of patients they transport. They correctly identified most patients who would be able to leave. Further work is needed to support these findings and ensure that EMS staff safely triage patients to alternative destinations of care.
英国的紧急医疗服务（EMS）工作人员通常会将所有紧急救援患者转运至最近的急诊科（ED）。救护车服务方面提议的改革意味着EMS工作人员不一定会将患者转运至最近的医院，而是转运至被判定患者需要其提供设施的医院。此前英国没有研究评估过EMS工作人员能多准确地预测哪些被转运患者需要住院治疗。
就EMS服务的合理使用情况对EMS工作人员进行调查，并确定他们是否能预测哪些患者需要住院治疗。
对在英国将患者转运至成人急诊科的EMS工作人员进行一项前瞻性“服务评估”。要求工作人员说明通过紧急救护车前往急诊科是否合适，以及被转运患者将从急诊科住院还是出院。
在研究期间，有2553次紧急转运至急诊科，396例（15.5%）完成了问卷调查。EMS工作人员预测182例（46.0%）将住院，214例（54.0%）将出院。实际处置情况分别为187例（47.2%）和209例（52.8%）。预测住院的敏感性为71.7%（95%可信区间65至78），特异性为77.0%（95%可信区间71至81）。EMS工作人员在预测非创伤病例的住院情况方面明显优于创伤病例（75.9%对57.1%，95%可信区间2.2至35.4）。
英国一家救护车服务机构的工作人员在预测他们转运患者的住院可能性时显示出合理的准确性。他们正确识别了大多数能够出院的患者。需要进一步开展工作来支持这些发现，并确保EMS工作人员安全地将患者分诊至其他护理目的地。
