Tavares Walter, Drennan Ian, Van Diepen Kelly, Abanil Michael, Kedzierski Natalie, Spearen Chris, Barrette Norm, Mercuri Mathew
Prehosp Emerg Care. 2017 Sep-Oct;21(5):652-661. doi: 10.1080/10903127.2017.1311391. Epub 2017 May 3.
Emergency departments (ED) continue to be overburdened, leading to crowding and elevated risk of negative clinical outcomes. Extending clinical services to paramedics may support efforts to improve ED burdens by promoting health care access and capacity during times of patient crisis. The objective of this study was to identify the clinical course and most responsible diagnosis of patients transported by paramedic services to local EDs to then evaluate impact of various augmented 9-1-1/paramedic clinical service models on the need for additional ED services.
A retrospective cohort and model-simulation based study. We retrieved clinical data from hospital records for a random selection of 3,000 patients who engaged 9-1-1/paramedic services and were transported to a regional ED to identify their clinical course (interventions, diagnostics) disposition and most responsible admitting/discharge diagnosis. We used this data to establish, simulate and test numerous paramedic service models on the need for ED services.
A random selection of 3,000 patients was reviewed across 3 hospitals. The majority were female (57.2%) with a mean age of 65 (SD = 21.3). The majority (n = 1954; 65.1%) were discharged directly from ED of which 3.6% (n = 108) received no intervention or diagnostic, 20.4% (n = 611) received only a diagnostic, 4.8% (n = 143) received only an intervention and 36.4% (n = 1092) received both an intervention and diagnostic. The proportion of nonadmitted patients rose to 82.2% and 77.2% when considering lower priority patients and age greater than 65, respectively. Patient types were identified based on frequency and association with discharge directly from ED. Twelve simulated augmented paramedic clinical service models are reported with estimated gains in the number of patients who may no longer require ED services ranging from 7.5% (n = 146) to 35.4% (n = 691).
This study suggests a reduction in need for ED services may be achieved through innovative models of paramedic services at the time of crisis. Identifying and confirming patient types/events to target and clinical services to include in the model requires ongoing investigation. Future research will be needed to evaluate the accuracy and impact of the models presented.
急诊科（ED）持续不堪重负，导致拥挤不堪，临床不良后果风险升高。将临床服务扩展至护理人员，可在患者危机时刻通过促进医疗服务可及性和能力，来支持减轻急诊科负担的努力。本研究的目的是确定由护理人员转运至当地急诊科的患者的临床病程及最主要诊断，进而评估各种增强型911/护理人员临床服务模式对额外急诊科服务需求的影响。
一项基于回顾性队列和模型模拟的研究。我们从医院记录中随机抽取3000名使用911/护理人员服务并被转运至区域急诊科的患者的临床数据，以确定他们的临床病程（干预措施、诊断结果）、处置情况以及最主要的入院/出院诊断。我们利用这些数据建立、模拟并测试了多种护理人员服务模式对急诊科服务需求的影响。
对3家医院随机抽取的3000名患者进行了回顾。大多数为女性（57.2%），平均年龄65岁（标准差 = 21.3）。大多数患者（n = 1954；65.1%）直接从急诊科出院，其中3.6%（n = 108）未接受任何干预或诊断，20.4%（n = 611）仅接受了诊断，4.8%（n = 143）仅接受了干预，36.4%（n = 1092）既接受了干预也接受了诊断。考虑优先级较低的患者以及年龄大于65岁的患者时，未入院患者的比例分别升至82.2%和77.2%。根据频率以及与直接从急诊科出院的关联确定了患者类型。报告了12种模拟的增强型护理人员临床服务模式，估计不再需要急诊科服务的患者数量增加幅度从7.5%（n = 146）到35.4%（n = 691）不等。
本研究表明，在危机时刻通过创新的护理人员服务模式，可能减少对急诊科服务的需求。确定并确认模型所针对的患者类型/事件以及纳入模型的临床服务，需要持续进行调查研究。未来需要开展研究以评估所提出模型的准确性和影响。
