Oosterwold Johan, Sagel Dennis, Berben Sivera, Roodbol Petrie, Broekhuis Manda
Department of Health Sciences - Nursing Research, UMC Groningen, Groningen, The Netherlands.
NHL Stenden, University of Applied Sciences, Leeuwarden, The Netherlands.
BMJ Open. 2018 Aug 30;8(8):e021732. doi: 10.1136/bmjopen-2018-021732.
The decision over whether to convey after emergency ambulance attendance plays a vital role in preventing avoidable admissions to a hospital's emergency department (ED). This is especially important with the elderly, for whom the likelihood and frequency of adverse events are greatest.
To provide a structured overview of factors influencing the conveyance decision of elderly people to the ED after emergency ambulance attendance, and the outcomes of these decisions.
A mixed studies review of empirical studies was performed based on systematic searches, without date restrictions, in PubMed, CINAHL and Embase (April 2018). Twenty-nine studies were included.
Only studies with evidence gathered after an emergency medical service (EMS) response in a prehospital setting that focused on factors that influence the decision whether to convey an elderly patient were included.
Prehospital, EMS setting; participants to include EMS staff and/or elderly patients after emergency ambulance attendance.
The Mixed Methods Appraisal Tool was used in appraising the included articles. Data were assessed using a 'best fit' framework synthesis approach.
ED referral by EMS staff is determined by many factors, and not only the acuteness of the medical emergency. Factors that increase the likelihood of non-conveyance are: non-conveyance guidelines, use of feedback loop, the experience, confidence, educational background and composition (male-female) of the EMS staff attending and consulting a physician, EMS colleague or other healthcare provider. Factors that boost the likelihood of conveyance are: being held liable, a lack of organisational support, of confidence and/or of baseline health information, and situational circumstances. Findings are presented in an overarching framework that includes the impact of these factors on the decision's outcomes.
Many non-medical factors influence the ED conveyance decision after emergency ambulance attendance, and this makes it a complex issue to manage.
在决定是否在紧急救护车出诊后将患者送往医院方面，这一决策对于防止不必要地入住医院急诊科起着至关重要的作用。这对于老年人尤为重要，因为他们发生不良事件的可能性和频率最高。
对影响老年人在紧急救护车出诊后被送往急诊科的转运决策的因素以及这些决策的结果进行结构化概述。
基于在PubMed、CINAHL和Embase（2018年4月）中进行的无日期限制的系统检索，对实证研究进行了混合研究综述。纳入了29项研究。
仅纳入那些在院前环境中紧急医疗服务（EMS）响应后收集证据、聚焦于影响是否转运老年患者决策的因素的研究。
院前，EMS环境；参与者包括EMS工作人员和/或紧急救护车出诊后的老年患者。
使用混合方法评估工具对纳入的文章进行评估。数据采用“最佳拟合”框架综合方法进行评估。
EMS工作人员将患者转诊至急诊科由多种因素决定，而不仅仅是医疗紧急情况的严重程度。增加不转运可能性的因素包括：不转运指南、反馈回路的使用、出诊并咨询医生、EMS同事或其他医疗服务提供者的EMS工作人员的经验、信心、教育背景和组成（男女比例）。增加转运可能性的因素包括：承担责任、缺乏组织支持、缺乏信心和/或缺乏基线健康信息以及情境情况。研究结果呈现在一个总体框架中，该框架包括这些因素对决策结果的影响。
许多非医疗因素影响紧急救护车出诊后送往急诊科的决策，这使得该问题难以管理。
