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Triage Ability of Emergency Medical Services Providers and Patient Disposition: A Prospective Study

Published online by Cambridge University Press:  28 June 2012

John R. Richards  and
Stephen J. Ferrall
John R. Richards*
Affiliation:
Division of Emergency Medicine, University of California, Davis Medical Center, Sacramento, California, USA
Stephen J. Ferrall
Affiliation:
Division of Emergency Medicine, University of California, Davis Medical Center, Sacramento, California, USA
*
MD Division of Emergency Medicine 2315 Stockton Boulevard Sacramento, CA 95817 USA E-mail: jrrichards@ucdavis.edu
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Abstract

Study objective:

To determine the ability of emergency medical services (EMS) providers to subjectively triage patients with respect to hospital admission and to determine patient characteristics associated with increased likelihood of admission.

Methods:

A prospective, cross-sectional study of a consecutive sample of patients arriving by ambulance during the month of February 1997 at an urban, university hospital, Emergency Department. Emergency medical services providers completed a questionnaire asking them to predict admission to the hospital and requested patient demographic information. Predictions were compared to actual patient disposition.

Results:

A total of 887 patients were included in the study, and 315 were admitted to the hospital (36%). With respect to admission, emergency medical services providers had an accuracy rate of 79%, with a sensitivity of 72% and specificity of 83% (kappa = 0.56). Blunt traumatic injury and altered mental status were the most common medical reasons for admission. Variables significantly associated with high admission rates were patients with age > 50 years, chest pain or cardiac complaints, shortness of breath or respiratory complaints, Medicare insurance, and Hispanic ethnicity. The emergency medical services providers most accurately predicted admission for patients presenting with labor (kappa = 1.0), shortness of breath / respiratory complaints (kappa = 0.84), and chest pain (kappa = 0.77).

Conclusion:

Emergency medical services providers can predict final patient disposition with reasonable accuracy, especially for patients presenting with labor, shortness of breath, or chest pain. Certain patient characteristics are associated with a higher rate of actual admission.

Keywords

admissionsambulancedecision-makingdispositionemergency departmentemergency medical services (EMS)hospitalsprehospitaltriage
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 14 , Issue 3 , September 1999 , pp. 67 - 72
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1999

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References

1. Brown, E, Sindelar, J: The emergent problem of ambulance misuse. Ann Emerg Med 1993;22:646–650.Google Scholar
2. Rademaker, AW, Powell, DG, Read, JH: Inappropriate use and unmet need in paramedic and nonparamedic ambulance systems. Ann Emerg Med 1987;16:553–556.Google Scholar
3. Gibson, G: Measures of emergency ambulance effectiveness: Unmet need and inappropriate use. JACEP 1977;6:389–392.Google Scholar
4. Billittier, AJ, Moscati, R, Janicke, D, Lerner, EB, Seymour, J, Olsson, D: A multisite survey of factors contributing to medically unnecessary ambulance transports. Acad Emerg Med 1996;3:1046–1052.Google Scholar
5. Gardener, GJ: The use and abuse of the emergency ambulance service: Some of the factors affecting the decision whether to call an emergency ambulance. Arch Emerg Med 1990;7:81–89.CrossRefGoogle Scholar
6. Sosin, M, Young, D, Dunt, DR: A study of emergency ambulance utilization. Aust Fam Physician 1989;12:233–238.Google Scholar
7. Pennycook, AG, Makower, RM, Morrison, WG: Use of the emergency ambulance service to an inner city accident and emergency department — A comparison of general pratitioner and 999 calls. J R Soc Med 1991;84:726–727.Google Scholar
8. O'Leary, C, Bury, G, McCabe, M, Kelly, C, McGoldrick, F, Ward, F: Ambulance-user analysis in an accident and emergency department. Ir Med J 1987;80:422–423.Google Scholar
9. Norcross, ED, Ford, DW, Cooper, ME, Zone-Smith, L, Byrne, TK, Yarbrough, DR: Application of American College of Surgeons' field triage guidelines by pre-hospital personnel. J Am Coll Surg 1995;181:539–544.Google Scholar
10. Baxt, WG, Berry, CC, Epperson, MD, Scalzitti, V: The failure of prehospital trauma prediction rules to classify trauma patients accurately. Ann Emerg Med 1989;18:1–8.Google Scholar
11. Zimmer-Gembeck, MJ, Southard, PA, Hedges, JR, Mullins, RJ, Rowland, D, Stone, JV, Trunkey, DD: Triage in an established trauma system. J Trauma 1995;39:922–928.Google Scholar
12. Culley, IX, Henwood, DK, Clark, JJ, Eisenberg, MS, Horton, C: Increasing the efficacy of emergency medical services by using criteria based dispatch. Ann Emerg Med 1994;24:867–872.Google Scholar
13. Palumbo, L, Kubincanek, J, Emerman, C, Jouriles, N, Cydulka, R, Shade, B: Performance of a system to determine emergency medical services dispatch priorities. Am J Emerg Med 1996;14:388–390.Google Scholar
14. Rottman, SJ, Schriger, DL, Charlop, G, Salas, JH, Lee, S: On-line medical control versus hospital-based prehospital care. Ann Emerg Med 1997;30:62–68.Google Scholar
15. Fries, GR, McCalla, G, Levitt, MA, Cordova, R: A prospective comparison of paramedic judgment and the trauma triage rule in the prehospital setting. Ann Emerg Med 1994;24:885–889.Google Scholar
16. Emerman, CL, Shade, B, Kubincanek, J: A comparison of EMT judgment and prehospital trauma triage instruments. J Trauma 1991;31:1369–1375.Google Scholar
17. Curka, PA, Pepe, P, Ginger, V, Sherrard, RC, Ivy, MV, Zachariah, BS: Emergency medical services priority dispatch. Ann Emerg Med 1993;22:1688–1695.Google Scholar
18. Cooper, ME, Yarbrough, DR, Zone-Smith, L, Byrne, TK, Norcross, ED: Application of field triage guidelines by pre-hospital personnel: Is mechanism of injury a valid guideline for patient triage? Am Surg 1995;61:363–367.Google Scholar
19. Bloch, DA, Kraemer, HC: 2 × 2 kappa coefficients: Measures of agreement or association. Biometrics 1989;45:269–287.Google Scholar
20. Schaider, JJ, Riccio, JC, Rydman, RJ, Pons, PT: Paramedic diagnostic accuracy for patients complaining of chest pain or shortness of breath. Prehospital and Disaster Medicine 1995;10:245–250.Google Scholar
21. Leprohon, J, Patel, VL: Decision-making strategies for telephone triage in emergency medical services. Med Decis Making 1995;15:240–253.Google Scholar
22. Grijseels, EW, Deckers, JW, Hoes, AW et al. : Implementation of a prehospital decision rule in general practice. Triage of patients with suspected myocardial infarction. Euro Heart J 1996;17:89–95.Google Scholar
23. Hu, SC, Kao, WF: Outcomes in severely injured patients transported without prehospital advanced life support. Am J Emerg Med 1996;14:86–88.Google Scholar
24. Branas, CC, Sing, RF, Davidson, SJ: Urban trauma transport of assaulted patients using nonmedical personnel. Acad Emerg Med 1995;2:486–493.Google Scholar
25. Selby, JV, Fireman, BH, Swain, BE: Effect of a co-payment on use of the emergency department in a health maintenance organization. N Engl J Med 1996;334:635–641.Google Scholar
26. Heilicser, B, Stocking, C, Steigler, M: Ethical dilemmas in emergency medical services: the perspectives of the emergency medical technician. Ann Emerg Med 1996;27:239–243.Google Scholar
27. Adams, JG, Arnold, R, Siminoff, L, Wolfson, AB: Ethical conflicts in the prehospital setting. Ann Emerg Med 1992;21:1259–1265.CrossRefGoogle ScholarPubMed
28. Zachariah, BS, Bryan, D, Pepe, P, Griffin, M: Follow-up and outcome of patients who decline or are denied transport by emergency medical services. Prehospital and Disaster Medicine 1992;7:359–363.Google Scholar
29. Selden, BS, Schnitzer, PG, Nolan, FX: Medicolegal documentation of prehospital triage. Ann Emerg Med 1990;19:547–551.Google Scholar
30. Soler, JM, Montes, MF, Egol, AB, Nateman, HR, Donaldson, EA, Greene, HH: The ten year malpractice experience of a large urban emergency medical services system. Ann Emerg Med 1985;14:982–985.Google Scholar
31. Goldberg, RJ, Zautcke, JL, Konigsberg, MD, Lee, RW; Nagorka, FW, Kling, M, Ward, SA: A review of prehospital care litigation in a large metropolitan emergency medical services system. Ann Emerg Med 1990;19:557–561.CrossRefGoogle Scholar
32. O'Brien, GM, Stein, MD, Zierler, S, Shapiro, M, O'Sullivan, P, Woolard, R: Use of the emergency department as a regular source of care: Associated factors beyond lack of health care insurance. Ann Emerg Med 1997;30:286–291.Google Scholar
33. Hayward, RA, Bernard, AM, Freeman, HE, Corey, CR: Regular source of ambulatory care and access to health services. Am J Public Health 1991;81:434–438.Google Scholar
34. Grumbach, K, Keane, D, Bindman, A: Primary care and public emergency department overcrowding. Am J Public Health 1993;83:372–378.Google Scholar
35. Lowe, RA, Young, GP, Reinke, B, White, JD, Auerbach, PS: Indigent health care in emergency medicine: An academic perspective. Ann Emerg Med 1991;20:790–794.Google Scholar
36. Derlet, RW, Kinser, D, Ray, L, Hamilton, B, McKenzie, J: Prospective identification and triage of nonemergency patients out of an emergency department: A 5 year study. Ann Emerg Med 1995;25:215–223.Google Scholar
37. Lowe, RA, Bindman, AB, Ulrich, SK et al. : Refusing care to emergency department patients: Evaluation of published triage guidelines. Ann Emerg Med 1994;23:286–293.Google Scholar
38. Neely, K, Drake, M, Moorehead, JC, Schmidt, TA, Skeen, DT, Wilson, EA: Multiple options and unique pathways: A new direction for emergency medical services? Ann Emerg Med 1997;30:797–799.Google Scholar
39. Dickinson, ET, Verdile, VP, Kostyun, CT, Salluzzo, RF: Geriatric use of emergency medical services. Ann Emerg Med 1996;27:199–203.Google Scholar
40. Gerson, LW, Skvarch, L: Emergency medical service utilization by the elderly. Ann Emerg Med 1982;11:610–612.Google Scholar
41. Wofford, JL, Schwartz, E, Timerding, BL, Folmar, S, Ellis, SD, Messick, CH: Emergency department utilization by the elderly: Analysis of the National Hospital Ambulatory Medical Care Survey. Acad Emerg Med 1996;3:694–699.Google Scholar
42. Brookoff, D, Minniti-Hill, M: Emergency department-based home care. Ann Emerg Med 1994;23:1101–1106.Google Scholar