Senior Lecturer, Department of Geography, 4547University of Lincoln, Lincoln, UK.
Professor of Primary and Pre-hospital Healthcare, Community and Health Research Unit, School of Health and Social Care, 4547University of Lincoln, Lincoln, UK.
J Health Serv Res Policy. 2023 Apr;28(2):138-146. doi: 10.1177/13558196221119913. Epub 2022 Aug 17.
In the context of increasing demand for ambulance services, emergency mental health cases are among the most difficult for ambulance clinicians to attend, partly because the cases often involve referring patients to other services. We describe the characteristics of mental health emergencies in the East Midlands region of the United Kingdom. We explore the association between 999 (i.e. emergency) call records, the clinical impressions of ambulance clinicians attending emergencies and the outcomes of ambulance attendance. We consider the implications of our results for optimizing patient care and ambulance service delivery.
We conducted a retrospective observational study of records of all patients experiencing mental health emergencies attended by ambulances between 1 January 2018 and 31 July 2020. The records comprised details of 103,801 '999' calls (Dispatch), the preliminary diagnoses by ambulance clinicians on-scene (Primary Clinical Impression) and the outcomes of ambulance attendance for patients (Outcome).
A multinomial regression analysis found that model fit with Outcome data was improved with the addition of Dispatch and Primary Clinical Impression categories compared to the fit for the model containing only the intercept and Outcome categories (Chi-square = 18,357.56, df = 180, < 0.01). Dispatch was a poor predictor of Primary Clinical impression. The most common predictors of Outcome care pathways other than 'Treated and transported' were records of respiratory conditions at Dispatch and anxiety reported by clinicians on-scene.
Drawing on the expertise of mental health specialists may help '999' dispatchers distinguish between physical and mental health emergencies and refer patients to appropriate services earlier in the response cycle. Further investigation is needed to determine if training Dispatch operatives for early triage and referral can be appropriately managed without compromising patient safety.
在对救护车服务需求不断增加的情况下，紧急心理健康案例是救护车临床医生最难处理的案例之一，部分原因是这些案例通常涉及将患者转介到其他服务部门。我们描述了英国东米德兰兹地区的心理健康紧急情况的特征。我们探讨了 999 （即紧急）呼叫记录、救护车临床医生对紧急情况的临床印象以及救护车出勤结果之间的关联。我们考虑了我们的研究结果对优化患者护理和救护车服务提供的影响。
我们对 2018 年 1 月 1 日至 2020 年 7 月 31 日期间由救护车处理的所有心理健康紧急情况患者的记录进行了回顾性观察研究。记录包括 103,801 次“999”呼叫（Dispatch）的详细信息、救护车临床医生现场初步诊断（Primary Clinical Impression）以及患者救护车出勤结果（Outcome）。
多分类回归分析发现，与仅包含截距和 Outcome 类别的模型相比，添加 Dispatch 和 Primary Clinical Impression 类别可提高对 Outcome 数据的模型拟合度（卡方=18,357.56，df=180，<0.01）。Dispatch 是 Primary Clinical Impression 的一个较差预测指标。除了“治疗和转运”以外，预测 Outcome 护理途径的最常见因素是 Dispatch 时记录的呼吸状况和临床医生现场报告的焦虑症状。
借鉴心理健康专家的专业知识，可能有助于“999”调度员区分身体和心理健康紧急情况，并在响应周期的早期将患者转介到适当的服务部门。需要进一步调查以确定是否可以在不影响患者安全的情况下对调度人员进行早期分诊和转介培训进行适当管理。
