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Physiological Scoring: An Aid to Emergency Medical Services Transport Decisions?

Published online by Cambridge University Press:  28 June 2012

Kirsty Challen  and
Darren Walter
Kirsty Challen*
Affiliation:
Health Services Research, ScHARR, University of Sheffield; Emergency Department, Central Manchester NHS Foundation Trust, Manchester, UK
Darren Walter
Affiliation:
Emergency Department, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
*
Emergency Department, Central Manchester NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK E-mail: [email protected]
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Abstract

Introduction:

Attendance at UK emergency departments is rising steadily despite the proliferation of alternative unscheduled care providers. Evidence is mixed on the willingness of emergency medical services (EMS) providers to decline to transport patients and the safety of incorporating such an option into EMS provision. Physiologically based Early Warning Scores are in use in many hospitals and emergency departments, but not yet have been proven to be of benefit in the prehospital arena.

Hypothesis:

The use of a physiological-social scoring system could safely identify patients calling EMS who might be diverted from the emergency department to an alternative, unscheduled, care provider.

Methods:

This was a retrospective, cohort study of patients with a presenting complaint of “shortness of breath” or “difficulty breathing” transported to the emergency department by EMS. Retrospective calculation of a physiologicalsocial score (PMEWS) based on first recorded data from EMS records was performed. Outcome measures of hospital admission and need for physiologically stabilizing treatment in the emergency department also were performed.

Results:

A total of 215 records were analyzed. One hundred thirty-nine (65%) patients were admitted from the emergency department or received physiologically stabilizing treatment in the emergency department. Area Under the Receiver Operating Characteristic Curve (AUROC) for hospital admission was 0.697 and for admission or physiologically stabilizing treatment was 0.710. No patient scoring <2 was admitted or received stabilizing treatment.

Conclusions:

Despite significant over-triage, this system could have diverted 79 patients safely from the emergency department to alternative, unscheduled, care providers.

Keywords

decision-makingemergency medical servicesphysiological scoringtransporttriage
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 25 , Issue 4 , August 2010 , pp. 320 - 323
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2010

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