Department of Health Research Methods, Evidence, and Impact (Strum, Worster, Griffith, Costa), McMaster Institute for Research and Aging (Griffith), Emergency Medicine Division (Worster), Department of Medicine, and Department of Medicine (Costa), McMaster University, Hamilton, Ont.; The Wilson Centre (Tavares), University of Toronto, Toronto, Ont.; York Region Paramedic and Senior Services (Tavares), Regional Municipality of York, Newmarket, Ont.
CMAJ Open. 2022 Jan 11;10(1):E1-E7. doi: 10.9778/cmajo.20210148. Print 2022 Jan-Mar.
As the number of patients with nonemergent conditions who are transported by paramedics continues to increase in Ontario, redirecting specific patients to subacute settings may be more beneficial and suitable for both patients and emergency departments. We aimed to evaluate whether emergency department interventions conducted on patients with nonemergent conditions who are transported by paramedics could be conducted in subacute health centres.
We conducted a RAND/UCLA modified Delphi study in Ontario between Oct. 13 and Dec. 19, 2020. We used purposive sampling to recruit practising emergency and primary care physicians for an expert panel. We abstracted interventions given to adult patients with nonemergent conditions (18 yr of age or older) who were transported by paramedics to an emergency department from the National Ambulatory Care Reporting System (NACRS) database (Jan. 1, 2014, to Mar. 31, 2018). Participants in the expert panel rated the suitability of the 150 most frequently recorded emergency department interventions from the NACRS database, for completion in subacute health care centres. We set consensus at 70% agreement.
We invited 25 physician experts, 21 of whom consented to participate; 20 physicians completed round 1, and 18 physicians completed both rounds. After 2 rounds, consensus was reached on 146 (97.3%) interventions; 103 interventions (68.7%) were suitable for subacute centres, 43 (28.7%) for only the emergency department and 4 (2.6%) did not receive consensus. For subacute centres, all 103 interventions were rated for urgent care centres; walk-in medical centres were applicable for 46 (30.6%) interventions and clinics led by nurse practitioners for 47 (31.3%) interventions.
Most interventions provided to patients with nonemergent conditions transported by paramedics to emergency departments were identified as suitable for urgent care clinics, with one-third being suitable for either walk-in medical centres or clinics led by nurse practitioners. This study has potential to inform a patient classification model for paramedic-initiated redirection of patients from emergency departments, although further contextualization is required for this to be implemented in clinical practice.
ID ISRCTN22901977.
随着安大略省非紧急情况患者由护理人员转运的数量不断增加，将特定患者重新引导到亚急性医疗机构可能对患者和急诊部门都更加有益和合适。我们旨在评估对由护理人员转运至急诊部的非紧急情况患者进行的急诊干预措施是否可在亚急性保健中心进行。
我们于 2020 年 10 月 13 日至 12 月 19 日在安大略省进行了一项 RAND/UCLA 改良 Delphi 研究。我们采用目的性抽样方法招募了从事急诊和初级保健的医生作为专家小组的成员。我们从国家非住院护理报告系统（NACRS）数据库（2014 年 1 月 1 日至 2018 年 3 月 31 日）中提取了由护理人员转运至急诊部的 18 岁及以上非紧急情况患者（18 岁及以上）接受的干预措施。专家小组成员对 NACRS 数据库中记录最频繁的 150 种急诊干预措施的适宜性进行了评分，以完成亚急性保健中心的治疗。我们将 70%的一致性设定为共识。
我们邀请了 25 名医生专家，其中 21 名同意参与；20 名医生完成了第一轮，18 名医生完成了两轮。经过两轮，对 146 项（97.3%）干预措施达成了共识；103 项（68.7%）干预措施适用于亚急性中心，43 项（28.7%）仅适用于急诊部，4 项（2.6%）未达成共识。对于亚急性中心，所有 103 项干预措施均适用于急症护理中心；46 项（30.6%）干预措施适用于门诊医疗中心，47 项（31.3%）干预措施适用于由执业护师主导的诊所。
对由护理人员转运至急诊部的非紧急情况患者提供的大多数干预措施被认为适用于急症护理诊所，其中三分之一适用于门诊医疗中心或由执业护师主导的诊所。这项研究有可能为护理人员发起的患者从急诊部重新分类提供信息，尽管在将其应用于临床实践之前需要进一步的背景化。
ID ISRCTN22901977。
