This study set out to evaluate the accuracy of Emergency Care Practitioners’ (ECP) opinions as to whether their actions result in patients avoiding attendance at an emergency department (ED) or a hospital admission. The authors argue that the difference in these two outcomes is important as they have different implications for patients and the healthcare system in relation to patients’ experiences, use of resources, and economic cost.
Based in Great Western Ambulance Service NHS Trust, this research builds on previous audit data and examines whether, having treated a patient on scene, ECPs believed that their clinical decision resulted in the avoidance of an ED attendance or hospital admission. In addition, the researchers wanted to compare these findings with those of an ED consultant and a General Practitioner (GP) in order to establish whether there was agreement between the three professional groups.
In total, seven participants (four paramedics; three nurses) took part in the study which was undertaken over a 10-week period from 1st September 2009. The ECPs completed a patient care record (PCR) for each of their patients, and they documented whether their actions resulted in avoidance of either an ED attendance or hospital admission.
Patients were included if the ECP treated them at the scene and did not convey them to hospital. Exclusion criteria comprised recognition of life extinct (ROLE), successful management and treatment of hypoglycaemia, patient refusal of treatment or transport, or if the call was home assistance only. Ultimately, 172 individual PCRs were reviewed by an ED consultant and a GP.
The findings demonstrate that ECPs believed that 11.6% (20/172) of their patients treated at scene avoided hospital admission as a result of their actions; the ED consultant identifed a 15.1% admission avoidance rate; with the GP reporting a 9.9% admission avoidance rate.
Overall, there was agreement between the ECPs, the ED consultant and the GP that in 80.2% (138/172) of cases the ECPs’ interventions resulted in the avoidance of an ED attendance or hospital admission.
An interesting finding was that four of the ECPs (three paramedics and one nurse) reported the same hospital admission avoidance rate as the ED consultant; the researchers note that these were the most experienced of the ECPs. Conversely, the two least experienced ECPs demonstrated higher levels of disagreement with the outcome decision of the ED consultant. Clearly this is an area worthy of further exploration in order to determine why this might be the case.
The authors openly discuss the limitations of the study, for example, the small sample size which restricts generalizability of th findings, and, the fact that th ED consultant and the GP had to base their decisions on secondary information reported in the PCR rather than on primary data gathered through their own assessment of the patients.
The researchers acknowledge that elements of the findings from this study would benefit from further investigation indicating that it would be useful to include a follow-up phase to identify whether patients had any subsequent attendance at the ED, or admission to hospital, related to the primary care episode. The paper concludes by suggesting that it would be feasible for other ambulance services to use this methodology to undertake similar evaluations.