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Abstract
Objectives The primary objective was to estimate the incidence of patients in the Central Denmark Region triaged to bypass the local emergency department without being part of a predefined fast-track protocol. The secondary objective was to describe these triage decisions in more detail with regard to the most common diagnoses, incidence of direct referral sorted by the prehospital critical care team (PHCCT) and the destination hospital.
Design Retrospective descriptive study.
Setting and participants The emergency medical service in the Central Denmark Region primarily consists of emergency medical technician (EMT)-staffed ambulances and anaesthesiologist-EMT-staffed PHCCTs. Patients treated by the nine ground-based PHCCTs in the region constituted the study population. The inclusion criteria were all patients treated by the PHCCTs during 2013 and 2014. The exclusion criteria were interhospital transfers, and patients with ST-segment elevation myocardial infarction, stroke or were in active labour.
Endpoints Incidence of prehospital critical care anaesthesiologist-initiated direct referral, prehospital tentative diagnoses and transport destination.
Results During the study period, the PHCCTs treated 39 396 patients and diverted 989 (2.5%) patients not covered by a predefined fast-track protocol to a specialised hospital department. ‘Resuscitated from cardiac arrest’ (n=143), ‘treatment and observations following road traffic accident’ (n=105) and ‘observation and treatment for an unspecified disease/condition’ (n=78) were the most common prehospital tentative diagnoses, accounting for 33.0% of all diverted patients. In total, 943 (95.3%) of the PHCCT-diverted patients were diverted to a department at Aarhus University Hospital.
Conclusion Our results demonstrate that in 1 out of 40 patient contacts, the anaesthesiologist-staffed PHCCTs in the Central Denmark Region divert critically ill and injured patients directly to a specialised hospital department, bypassing local emergency departments and potentially reducing time to definitive care for these patients. There may be a potential for increased referral of patients with no predefined fast-track directly to specialised departments in the Central Denmark Region.
- EMS
- pre-hospital
- critical care
- anaesthesiologist
- triage
- decision-making
- definitive care
- specialised department
- Central Denmark Region
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Footnotes
Contributors LR conceived the study. MLF and LR designed the study. LR identified all relevant diagnoses and receiving hospitals for each PHCCT representing a direct referral to specialised department, and defined the inclusion and exclusion criteria. MLF performed the literature review and the identification of eligible patients from the prehospital database. MLF and LR analysed and interpreted the data. MLF wrote the manuscript. LR reviewed the manuscript. Both authors have read and approved the final manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Not required.
Ethics approval Given that this study is a retrospective descriptive study using anonymised data and a database previously approved by the Danish Data Protection Agency, consent from the ethical committee was not needed according to Danish law. No individual patients can be identified in our results.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All data generated or analysed during this study are included in this published article and in the full data set available from the Figshare Repository (DOI: 10.6084/m9.figshare.5852967).
Author note MLF is working as a medical doctor at the Department of Thoracic Medicine at Haukeland University Hospital. The research was performed during MLF’s fifth and sixth year as a medical student at Aarhus University. LR is the lead clinician for the Pre-hospital Critical Care Service in Aarhus and the HEMS physician with the Danish Air Ambulance. He is an associate professor of prehospital care at Aarhus University.