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10.5811/westjem.2016.9.31384 http://scihub22266oqcxt.onion/10.5811/westjem.2016.9.31384 C5102593!5102593 !27833674     free     free     free Warning: file_get_contents(https://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=27833674 &cmd=llinks): Failed to open stream: HTTP request failed! 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Alternative Destination Transport? The Role of Paramedics in Optimal Use of the Emergency Department |pdf=|usr=}}{{27833674 }} gab.com Text Alternative Destination Transport The Role of Paramedics in Optimal Use of the Emergency Department JO: West J Emerg Med http://www.kidney.de/pget.php?&tw=1&pmid=27833674 #FOAvip INTRODUCTION: Alternative destination transportation by emergency medical services (EMS) is a subject of hot debate between those favoring all patients being evaluated by an emergency physician (EP) and those recognizing the need to reduce emergency department (ED) crowding. This study aimed to determine whether paramedics could accurately assess a patient's acuity level to determine the need to transport to an ED. METHODS: We performed a prospective double-blinded analysis of responses recorded by paramedics and EPs of arriving patients' acuity level in a large Level II trauma center between April 2015 and November 2015. Under-triage was defined as lower acuity assessed by paramedics but higher acuity by EPs. Over-triage was defined as higher acuity assessed by paramedics but lower acuity by EPs. The degree of agreement between the paramedics and EPs' evaluations of patient's acuity level was compared using Chi-square test. RESULTS: We included a total of 503 patients in the final analysis. For paramedics, 2 51 (49.9%) patients were assessed to be emergent, 178 (35.4%) assessed as urgent, and 74 (14.7%) assessed as non-emergent/non-urgent. In comparison, the EPs assessed 296 (58.9%) patients as emergent, 148 (29.4%) assessed as urgent, and 59 (11.7%) assessed as non-emergent/non-urgent. Paramedics agreed with EPs regarding the acuity level assessment on 71.8% of the cases. The overall under- and over-triage were 19.3% and 8.9%, respectively. A moderate Kappa=0.5174 indicated moderate inter-rater agreement between paramedics' and EPs' assessment on the same cohort of patients. CONCLUSION: There is a significant difference in paramedic and physician assessment of patients into emergent, urgent, or non-emergent/non-urgent categories. The field triage of a patient to an alternative destination by paramedics under their current scope of practice and training cannot be supported. Twit Text FOAVip Alternative Destination Transport The Role of Paramedics in Optimal Use of the Emergency Department ????West J Emerg Med http://www.kidney.de/pget.php?&tw=1&pmid=27833674 #FOAvip Twit Text # Free Paper on # # # # # LINK http://www.kidney.de/pget.php?&tw=1&pmid=27833674 #FOAvip English Wikipedia <ref>{{Cite pmid|27833674 }}</ref> Alternative Destination Transport? The Role of Paramedics in Optimal Use of the Emergency Department #MMPMID27833674 Neeki MM ; Dong F ; Avera L ; Than T ; Borger R ; Powell J ; Vaezazizi R ; Pitts R West J Emerg Med 2016[Nov]; 17 (6 ): 690-697 PMID27833674 show ga INTRODUCTION: Alternative destination transportation by emergency medical services (EMS) is a subject of hot debate between those favoring all patients being evaluated by an emergency physician (EP) and those recognizing the need to reduce emergency department (ED) crowding. This study aimed to determine whether paramedics could accurately assess a patient's acuity level to determine the need to transport to an ED. METHODS: We performed a prospective double-blinded analysis of responses recorded by paramedics and EPs of arriving patients' acuity level in a large Level II trauma center between April 2015 and November 2015. Under-triage was defined as lower acuity assessed by paramedics but higher acuity by EPs. Over-triage was defined as higher acuity assessed by paramedics but lower acuity by EPs. The degree of agreement between the paramedics and EPs' evaluations of patient's acuity level was compared using Chi-square test. RESULTS: We included a total of 503 patients in the final analysis. For paramedics, 2 51 (49.9%) patients were assessed to be emergent, 178 (35.4%) assessed as urgent, and 74 (14.7%) assessed as non-emergent/non-urgent. In comparison, the EPs assessed 296 (58.9%) patients as emergent, 148 (29.4%) assessed as urgent, and 59 (11.7%) assessed as non-emergent/non-urgent. Paramedics agreed with EPs regarding the acuity level assessment on 71.8% of the cases. The overall under- and over-triage were 19.3% and 8.9%, respectively. A moderate Kappa=0.5174 indicated moderate inter-rater agreement between paramedics' and EPs' assessment on the same cohort of patients. CONCLUSION: There is a significant difference in paramedic and physician assessment of patients into emergent, urgent, or non-emergent/non-urgent categories. The field triage of a patient to an alternative destination by paramedics under their current scope of practice and training cannot be supported. |*Clinical Competence [MESH] |*Emergency Medical Services [MESH] |*Transportation of Patients [MESH] |Crowding [MESH] |Emergency Medical Technicians/standards/*statistics & numerical data [MESH] |Humans [MESH] |Physicians/*standards/statistics & numerical data [MESH] |Prospective Studies [MESH] |Surveys and Questionnaires [MESH]Alternative Destination Transport? The Role of Paramedics in Optimal U(epmc).pdf DeepDyve Pubget Overpricing