Results of an evaluation of the effectiveness of triage and direct transportation to minor injuries units by ambulance crews.
OBJECTIVE
To evaluate triage and transportation to a minor injury unit (MIU) by emergency ambulance crews.


METHODS
Ambulance crews in two services were asked to transport appropriate patients to MIU during randomly selected weeks of one year. During all other weeks they were to treat such patients according to normal practice. Patients were followed up through ambulance service, hospital and/or MIU records, and by postal questionnaire. Semi-structured interviews were undertaken with crews (n = 15). Cases transferred from MIU to accident and emergency (A&E) were reviewed.


RESULTS
41 intervention cluster patients attended MIU, 303 attended A&E, 65 were not conveyed. Thirty seven control cluster patients attended MIU, 327 attended A&E, 61 stayed at scene. Because of low study design compliance, outcomes of patients taken to MIU were compared with those taken to A&E, adjusted for case mix. MIU patients were 7.2 times as likely to rate their care as excellent (95% CI 1.99 to 25.8). Ambulance service job-cycle time and time in unit were shorter for MIU patients (-7.8, 95% CI -11.5 to -4.1); (-222.7, 95%CI -331.9 to -123.5). Crews cited patient and operational factors as inhibiting MIU use; and location, service, patient choice, job-cycle time, and handover as encouraging their use. Of seven patients transferred by ambulance from MIU to A&E, medical reviewers judged that three had not met the protocol for conveyance to MIU. No patients were judged to have suffered adverse consequences.


CONCLUSIONS
MIUs were only used for a small proportion of eligible patients. When they were used, patients and the ambulance service benefited.
Snooks
H
H
Clinical School, University of Wales Swansea, UK. h.a.snooks@swan.ac.uk
Foster
T
T
Nicholl
J
J
D000059:Accidents; D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances; D016009:Chi-Square Distribution; D002983:Clinical Competence; D004634:Emergency Medical Technicians; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D014193:Trauma Centers; D016896:Treatment Outcome; D014218:Triage / Q000592:standards*