Holzinger Felix, Kümpel Lisa, Resendiz Cantu Rebecca, Alberter Anja, Möckel Martin, Heintze Christoph
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. 2025 Jul 30;25(1):138. doi: 10.1186/s12873-025-01295-9.
Emergency medical services (EMS) are frequently used by low-acuity patients, which contributes to emergency department (ED) crowding. The feasibility of EMS transporting low-acuity patients directly to general practitioner (GP) practices remains a matter of debate. We therefore investigated the circumstances of EMS utilization in patients who subsequently receive ambulatory treatment in the ED. We wanted to find out how often a primary care (PC) consultation could have been a suitable alternative in such cases.
Low-acuity ED utilizers transported by EMS were surveyed on demographics and medical characteristics and asked about the appropriateness and acceptability of a potential PC redirection, supplemented with case assessments by EMS personnel. Additionally, treatment documentation from both the ED and EMS was analyzed. Descriptive statistics were conducted. Associations between categorical variables were examined by Chi tests.
A total of n = 358 low-acuity EMS participants were recruited. Participants had a mean age of 47.6 years; gender f/m: 58.1%/41.9%. In the hospital, 71.8% were assigned to the Manchester triage system (MTS) category 3 and 28.0% to category 4. A third of the patients had decided to alert EMS at their discretion, while other people (e.g., relatives, colleagues) had been involved twice as often. Patients most commonly cited severe symptoms and related fears as reasons for engaging EMS services. EMS personnel categorized the complaints as treatable by a GP in 37.0%, while 44.5% of patients would have been open to PC management. However, these assessments exhibited substantial discrepancies, as evidenced by a Cohen's Kappa coefficient of approximately 0.1. From a preclinical perspective, only 24.4% of cases met the criteria for potentially realistic diversion. These encompassed both patient openness to alternative care pathways and EMS discernment of cases as potentially appropriate.
PC diversion is estimated to be feasible for a maximum of a quarter of ED outpatients. Markers for potential management in PC show highly discrepant results, and there is no validated system or score for preclinical identification of patients eligible for safe redirection. As EMS is intended for high-acuity emergencies, such patients could potentially also benefit from options like telemedicine care at home or alternative transportation.
German Clinical Trials Register (DRKS00023480); date: 27/11/2020.
低 acuity 患者经常使用紧急医疗服务（EMS），这加剧了急诊科（ED）的拥挤。EMS 将低 acuity 患者直接转运至全科医生（GP）诊所的可行性仍存在争议。因此，我们调查了随后在 ED 接受门诊治疗的患者使用 EMS 的情况。我们想了解在这些情况下，初级保健（PC）咨询作为合适替代方案的频率有多高。
对由 EMS 转运的低 acuity ED 使用者进行了人口统计学和医学特征调查，并询问了潜在 PC 转诊的适宜性和可接受性，同时补充了 EMS 人员的病例评估。此外，还分析了 ED 和 EMS 的治疗记录。进行了描述性统计。通过卡方检验检查分类变量之间的关联。
共招募了 n = 358 名低 acuity EMS 参与者。参与者的平均年龄为 47.6 岁；性别女/男：58.1%/41.9%。在医院，71.8%被分配到曼彻斯特分诊系统（MTS）3 类，28.0%被分配到 4 类。三分之一的患者自行决定呼叫 EMS，而其他人（如亲属、同事）参与的频率是前者的两倍。患者最常将严重症状和相关恐惧作为使用 EMS 服务的原因。EMS 人员将 37.0%的投诉归类为可由 GP 治疗，而 44.5%的患者愿意接受 PC 管理。然而，这些评估存在很大差异，科恩卡帕系数约为 0.1 就证明了这一点。从临床前的角度来看，只有 24.4%的病例符合潜在现实性转诊的标准。这些既包括患者对替代护理途径的接受程度，也包括 EMS 对病例是否可能合适的判断。
估计 PC 转诊对最多四分之一的 ED 门诊患者可行。PC 潜在管理的指标显示结果差异很大，并且没有经过验证的系统或评分用于临床前识别适合安全转诊的患者。由于 EMS 用于高 acuity 紧急情况，此类患者也可能从诸如家庭远程医疗护理或替代交通等选择中受益。
德国临床试验注册中心（DRKS00023480）；日期：2020 年 11 月 27 日。
