Patient characteristics, triage utilisation, level of care, and outcomes in an unselected adult patient population seen by the emergency medical services: a prospective observational study

Patient characteristics, triage utilisation, level of care, and outcomes in an unselected adult patient population seen by the emergency medical services: a prospective observational study

Patient safety, Emergency medical services, Triage, Patient assessment, Non-transport, Prehospital

Background: Crowding in the emergency department (ED) is a safety concern, and pathways to bypass the ED
have been introduced to reduce the time to definitive care. Conversely, a number of low-acuity patients in the ED
could be assessed by the emergency medical services (EMS) as requiring a lower level of care. The limited access to
primary care in Sweden leaves the EMS nurse to either assess the patient as requiring the ED or to stay at the
scene. This study aimed to assess patient characteristics and evaluate the initial assessment by and utilisation of the
ambulance triage system and the appropriateness of non-transport decisions.
Methods: A prospective observational study including 6712 patients aged ≥16 years was conducted. The patient
records with 72 h of follow-up for non-transported patients were reviewed. Outcomes of death, time-critical
conditions, complications within 48 h and final hospital assessment were evaluated. The Mann-Whitney U test,
Fisher’s exact test, and Spearman’s rank correlation were used for statistical analysis.
Results: The median patient age was 66 years, and the most common medical history was a circulatory diagnosis.
Males received a higher priority from dispatchers and were more frequently assessed at the scene as requiring
hospital care. A total of 1312 patients (19.7%) were non-transported; a history of psychiatric disorders or no medical
history was more commonly noted among these patients. Twelve (0.9%) of the 1312 patients not transported were
later admitted with time-critical conditions. Full triage was applied in 77.4% of the cases, and older patients were
triaged at the scene as an ‘unspecific condition’ more frequently than younger patients. Overall, the 30-day
mortality was 4.1% (n = 274).
Conclusions: Age, sex, medical history, and presentation all appear to influence the initial assessment. A number of
patients transported to ED could be managed at a lower level of care. A small proportion of the non-transported
patients were later diagnosed with a time-critical condition, warranting improved assessment tools at the scene
and education of the personnel focusing on the elderly population. These results may be useful in addressing
resource allocation issues aiming at increasing patient safety.

Carl Magnusson , Johan Herlitz and Christer Axelsson

BMC Emergency Medicine

(2020) 20:7

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