Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany.
Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Division of Emergency Medicine, Campus Mitte and Virchow, Charitéplatz 1, 10117, Berlin, Germany.
BMC Emerg Med. 2022 Jun 11;22(1):103. doi: 10.1186/s12873-022-00660-2.
Against the backdrop of emergency department (ED) overcrowding, patients' potential redirection to outpatient care structures is a subject of current political debate in Germany. It was suggested in this context that suitable lower-urgency cases could be transported directly to primary care practices by emergency medical services (EMS), thus bypassing the ED. However, practicality is discussed controversially. This qualitative study aimed to capture the perspective of EMS personnel on potential patient redirection concepts.
We conducted qualitative, semi-structured phone interviews with 24 paramedics. Interviews were concluded after attainment of thematic saturation. Interviews were transcribed verbatim, and qualitative content analysis was performed.
Technical and organizational feasibility of patients' redirection was predominantly seen as limited (theme: "feasible, but only under certain conditions") or even impossible (theme: "actually not feasible"), based on a wide spectrum of potential barriers. Prominently voiced reasons were restrictions in personnel resources in both EMS and ambulatory care, as well as concerns for patient safety ascribed to a restricted diagnostic scope. Concerning logistics, alternative transport options were assessed as preferable. Regarding acceptance by stakeholders, the potential for releasing ED caseload was described as a factor potentially promoting adoption, while doubt was raised regarding acceptance by EMS personnel, as their workload was expected to conversely increase. Paramedics predominantly did not consider transporting lower-urgency cases as their responsibility, or even as necessary. Participants were markedly concerned of EMS being misused for taxi services in this context and worried about negative impact for critically ill patients, as to vehicles and personnel being potentially tied up in unnecessary transports. As to acceptance on the patients' side, interview participants surmised a potential openness to redirection if this would be associated with benefits like shorter wait times and accompanied by proper explanation.
Interviews with EMS staff highlighted considerable doubts about the general possibility of a direct redirection to primary care as to considerable logistic challenges in a situation of strained EMS resources, as well as patient safety concerns. Plans for redirection schemes should consider paramedics' perspective and ensure a provision of EMS with the resources required to function in a changing care environment.
在急诊科（ED）人满为患的背景下，将患者潜在地重新分配到门诊护理结构是德国当前政治辩论的主题。在这种情况下，有人建议，紧急医疗服务（EMS）可以将适当的低紧急度病例直接送往初级保健诊所，从而绕过 ED。然而，其实用性存在争议。这项定性研究旨在了解 EMS 人员对潜在患者重新定向概念的看法。
我们对 24 名护理人员进行了定性、半结构式电话访谈。在达到主题饱和后结束访谈。对访谈进行逐字转录，并进行定性内容分析。
基于广泛的潜在障碍，技术和组织可行性主要被认为是有限的（主题：“可行，但仅在某些条件下”）或甚至不可能（主题：“实际上不可行”）。突出的原因是 EMS 和门诊护理人员资源的限制，以及由于诊断范围受限而对患者安全的担忧。在物流方面，替代运输选择被评估为更可取。关于利益相关者的接受度，释放 ED 病例量的潜力被描述为促进采用的因素，而对 EMS 人员的接受度则存在疑问，因为预计他们的工作量会相应增加。护理人员主要不认为运送低紧急度病例是他们的责任，甚至认为没有必要。参与者对 EMS 在这种情况下被滥用于出租车服务表示明显担忧，并担心对危重病患者产生负面影响，因为车辆和人员可能会被不必要的运输所牵制。至于患者方面的接受度，访谈参与者推测，如果与缩短等待时间等好处相关，并且伴随着适当的解释，那么患者可能会对重新定向持开放态度。
对 EMS 工作人员的访谈突出了对直接重新定向到初级保健的总体可能性的相当大的怀疑，因为在 EMS 资源紧张的情况下存在相当大的物流挑战，以及对患者安全的担忧。重新定向计划应考虑到护理人员的观点，并确保 EMS 提供在不断变化的护理环境中运作所需的资源。
