Møller Frederikke Amalie, Persson Mads Lillethorup, Engholm Elisabeth Larsen, Jensen Penille Horsbøl Kirkegaard, Vaeggemose Ulla, Gehrt Tine Bennedsen
Department of Research and Development, Prehospital Emergency Medical Services, Central Denmark Region, Brendstrupgårdsvej 7, 2. th., Aarhus N, 8200, Denmark.
Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark.
BMC Health Serv Res. 2025 Feb 25;25(1):307. doi: 10.1186/s12913-025-12448-8.
The growing demand for acute medical assistance creates an increasing pressure on emergency medical services (EMS) and emergency departments. This calls for initiatives to prevent avoidable admissions. A novel non-conveyance solo-ambulance was introduced in the Central Denmark Region; the Prehospital Visitation Unit (PVU). We investigated patient characteristics and prehospital management by the PVU, while exploring employee perspectives on the implementation process and how they perceived their expanded role and responsibilities working with the PVU.
This mixed-methods study had a convergent parallel design. Patient data was collected on all patients assessed by the PVU between April 1st 2022 and April 1st 2023. Furthermore, 19 semi-structured interviews with paramedics, EMS dispatchers and technical dispatchers partaking in the operation of the PVU were conducted. Interviews were analyzed using thematic analysis with an inductive approach, drawing on principles from grounded theory.
Throughout the study period, the PVU served 1510 patients (median age: 60, IQR: 33-77). Among these, 83.6% were assigned an urgency level B, indicating acute, but not life-threatening, situations. Patients presented with a broad range of complaints, including a high number of patients with non-specific complaints. Paramedics completed treatment on-scene for 29.1% of all patients, spending a median time of 49 min (IQR: 33-64) on-scene. In the interviews, four themes were identified: (1) The implementation strategy had gaps, but was supported by ongoing adjustments, (2) Facilitating a patient-centered approach for the benefit of the patient and the system, (3) Community partnership and internal collaboration enabled paramedics as healthcare facilitators, and (4) Flexible workflows were needed to maintain professional agency.
The PVU seems to offer a valuable alternative within the EMS, particularly for patients with non-specific complaints and conditions manageable at a lower level of care. Strong collaboration allowed paramedics to take on a facilitating role, creating appropriate pathways and providing patient-centered care. However, for successful implementation, ongoing adjustments were required, particularly in maintaining the professional autonomy of the healthcare professionals. As prehospital EMS increasingly respond to non-acute medical needs, initiatives like the PVU can play an important role in meeting growing demands.
对急性医疗救助的需求不断增长，给紧急医疗服务（EMS）和急诊科带来了越来越大的压力。这就需要采取措施来防止不必要的住院治疗。丹麦中部地区引入了一种新型的非转运单人救护车，即院前出诊单元（PVU）。我们调查了PVU的患者特征和院前管理情况，同时探讨了员工对实施过程的看法，以及他们如何看待在与PVU合作中扩大的角色和职责。
这项混合方法研究采用了收敛平行设计。收集了2022年4月1日至2023年4月1日期间由PVU评估的所有患者的数据。此外，还对参与PVU运营的护理人员、EMS调度员和技术调度员进行了19次半结构化访谈。访谈采用主题分析的归纳法进行分析，借鉴扎根理论的原则。
在整个研究期间，PVU为1510名患者提供了服务（中位年龄：60岁，IQR：33 - 77岁）。其中，83.6%的患者被分配到B级紧急程度，表明是急性但不危及生命的情况。患者表现出各种各样的症状，包括大量有非特异性症状的患者。护理人员在现场为29.1%的患者完成了治疗，在现场花费的中位时间为49分钟（IQR：33 - 64分钟）。在访谈中，确定了四个主题：（1）实施策略存在差距，但通过持续调整得到了支持；（2）促进以患者为中心的方法，以造福患者和系统；（3）社区伙伴关系和内部合作使护理人员成为医疗服务促进者；（4）需要灵活的工作流程来维持专业自主性。
PVU似乎在EMS中提供了一种有价值的选择，特别是对于那些有非特异性症状且在较低护理水平下可管理的患者。强大的合作使护理人员能够发挥促进作用，创造适当的途径并提供以患者为中心的护理。然而，为了成功实施，需要持续调整，特别是在维护医疗专业人员的职业自主权方面。随着院前EMS越来越多地应对非急性医疗需求，像PVU这样的举措可以在满足不断增长的需求方面发挥重要作用。
