To alert, or not to alert? That is the question

Pre-hospital alerts provide the emergency department (ED) with time to mobilise specialist teams and prepare essential equipment to ensure the most appropriate care is given to time-critical patients. Providing pre-alerts to EDs is something all ambulance crews have experience of; however, which patients require a pre-alert remains controversial.

This study set out to investigate the ‘impact of a new pre-alert tool on current alerting practice and evaluate its ability to take the place of a prehospital early warning system.’ This study included a total of 104 patients who were taken by ambulance to the resuscitation area of the Aberdeen Royal Infirmary ED, over a seven week period in 2012. These patients were recruited opportunistically at the time of arrival by the investigator at a variety of times including evenings, nights and weekends.

Collected data included age, gender, presenting problem, alert status and whether an alert would have been prompted by the new pre-alert tool. Each case was reviewed by a consultant from the department, who was blinded to alert status, therefore limiting any potential bias, whose opinion was sought as to whether a pre-alert would have been appropriate. The authors state this allowed the development of a ‘pragmatic alert requirement for each case,’ which enabled a comparison between the alert tool and the ambulance crews' decisions. It was judged that out of the 104 patients, 90 required a pre-alert.