Fraess-Phillips Alex J
School of Health Sciences,University of Northern British Columbia,Prince George,British Columbia,Canada.
Prehosp Disaster Med. 2016 Dec;31(6):667-674. doi: 10.1017/S1049023X16000935. Epub 2016 Sep 19.
The goal of this search was to review the current literature regarding paramedic triage of primary care patients and the safety of paramedic-initiated non-transport of non-urgent patients.
A narrative literature review was conducted using the Medline (Medline Industries, Inc.; Mundelein, Illinois USA) database and a manual search of Google Scholar (Google; Mountain View, California USA).
Only 11 studies were found investigating paramedic triage and safety of non-transport of non-urgent patients. It was found that triage agreement between paramedic and emergency department staff generally is poor and that paramedics are limited in their abilities to predict the ultimate admission location of their patients. However, these triage decisions and admission predictions are much more accurate when the patient's condition is the result of trauma and when the patient requires critical care services. Furthermore, the literature provides very limited support for the safety of paramedic triage in the refusal of non-urgent patient transport, especially without physician oversight. Though many non-transported patients are satisfied with the quality of non-urgent treatment that they receive from paramedics, the rates of under-triage and subsequent hospitalization reported in the literature are too high to suggest that this practice can be adopted widely.
There is insufficient evidence to suggest that non-urgent patients can safely be refused transport based on paramedic triage alone. Further attempts to implement paramedic-initiated non-transport of non-urgent patients should be approached with careful triage protocol development, paramedic training, and pilot studies. Future primary research and systematic reviews also are required to build on the currently limited literature. Fraess-Phillips AJ . Can paramedics safely refuse transport of non-urgent patients? Prehosp Disaster Med. 2016;31(6):667-674.
本次检索的目的是回顾当前关于护理人员对初级护理患者进行分诊以及护理人员发起的非紧急患者非转运安全性的文献。
使用Medline数据库（美国伊利诺伊州芒德林市的Medline Industries公司）进行叙述性文献综述，并对谷歌学术（美国加利福尼亚州山景城的谷歌公司）进行手动检索。
仅发现11项研究调查了护理人员分诊及非紧急患者非转运的安全性。结果发现，护理人员与急诊科工作人员之间的分诊一致性普遍较差，且护理人员预测患者最终收治地点的能力有限。然而，当患者病情由创伤导致以及患者需要重症监护服务时，这些分诊决策和收治预测要准确得多。此外，对于护理人员在拒绝非紧急患者转运时进行分诊的安全性，文献提供的支持非常有限，尤其是在没有医生监督的情况下。尽管许多未被转运的患者对他们从护理人员那里获得的非紧急治疗质量感到满意，但文献中报道的分诊不足率和随后的住院率过高，表明这种做法不能广泛采用。
没有足够的证据表明仅基于护理人员的分诊就可以安全地拒绝非紧急患者的转运。进一步尝试实施护理人员发起的非紧急患者非转运时，应谨慎制定分诊方案、开展护理人员培训并进行试点研究。还需要未来的初步研究和系统评价，以在目前有限的文献基础上进一步拓展。弗雷斯 - 菲利普斯AJ。护理人员能否安全拒绝转运非紧急患者？院前灾难医学。2016；31(6)：667 - 674。
