Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
The Wilson Centre and Post MD Education, University of Toronto, Toronto, Ontario, Canada.
BMJ Open. 2021 Jan 20;11(1):e045351. doi: 10.1136/bmjopen-2020-045351.
Ontario ambulances are restricted from patient transportation to sub-acute levels of care when these facilities may be more suitable than emergency departments for non-emergent conditions. There is no known patient classification specifically constructed to inform ED diversion protocols and guidance for sub-acute centre transportation for primary care-like patient conditions.
To construct a novel patient classification of potentially preventable emergency department visits following transport by ambulance, and analyse patient-level characteristic associations with this classification based in Ontario secondary data.
The Primary Care-like Ambulance transports following Response for 911-Emergencies (PriCARE) patient classification will be constructed using a two-phase RAND/UCLA modified Delphi design. All experts included are physicians with relevant experience in emergency and/or primary care in Ontario. The first phase of the study will determine consensus of the expert committee on which ED interventions performed on patients with non-emergent acuities could be conducted in sub-acute healthcare centres. The second phase will assess consensus of which patient, hospital and acuity factors are most appropriate to be incorporated into a PriCARE classification. We will also investigate secondary outcomes on consensus of which ED interventions could be transferred to a paramedic context given an expanded scope of practice and patient-level characteristics of PriCARE classified individuals.
This study received a research ethics board exemption waiver from the Hamilton Integrated Research Ethics Board; review reference 2020-11451-GRA. Results will be submitted for publication in a peer-reviewed journal and presented at relevant conferences. The results will be shared with Ontario paramedic services and governing institutions. This study will be used to inform patient classification protocols and clinical decision tools for ambulances to transport to sub-acute healthcare centres.
ISRCTN22901977.
安大略省的救护车在将患者送往亚急性护理水平时受到限制，而这些设施在非紧急情况下可能比急诊部门更适合。目前还没有专门构建的患者分类来告知急诊科分流协议，并为初级保健类患者的亚急性中心转运提供指导。
构建一种新的潜在可预防的急诊科就诊患者分类，用于分析安大略省二次数据中基于患者水平特征与该分类的关联。
使用两轮 RAND/UCLA 改良 Delphi 设计来构建类似于初级保健的救护车转运后出现的紧急情况（PriCARE）患者分类。所有参与的专家都是在安大略省具有急诊和/或初级保健相关经验的医生。研究的第一阶段将确定专家委员会对哪些非紧急急症患者的急诊科干预措施可以在亚急性医疗中心进行的共识。第二阶段将评估哪些患者、医院和严重程度因素最适合纳入 PriCARE 分类的共识。我们还将调查在扩大执业范围和 PriCARE 分类个体的患者水平特征的背景下，哪些急诊科干预措施可以转移到护理人员手中的共识的次要结果。
这项研究获得了汉密尔顿综合研究伦理委员会的豁免研究伦理委员会审查参考号 2020-11451-GRA。研究结果将提交给同行评审期刊发表，并在相关会议上展示。研究结果将与安大略省护理人员服务和管理机构共享。这项研究将用于为救护车送往亚急性医疗机构的患者分类协议和临床决策工具提供信息。
ISRCTN22901977。
