Physiological scoring: an aid to emergency medical services transport decisions?
BACKGROUND
Attendance at UK emergency departments is rising steadily despite the proliferation of alternative unscheduled care providers. Evidence is mixed on the willingness of emergency medical services (EMS) providers to decline to transport patients and the safety of incorporating such an option into EMS provision. Physiologically based Early Warning Scores are in use in many hospitals and emergency departments, but not yet have been proven to be of benefit in the prehospital arena.


OBJECTIVE
The use of a physiological-social scoring system could safely identify patients calling EMS who might be diverted from the emergency department to an alternative, unscheduled, care provider.


METHODS
This was a retrospective, cohort study of patients with a presenting complaint of "shortness of breath" or "difficulty breathing" transported to the emergency department by EMS. Retrospective calculation of a physiological social score (PMEWS) based on first recorded data from EMS records was performed. Outcome measures of hospital admission and need for physiologically stabilizing treatment in the emergency department also were performed.


RESULTS
A total of 215 records were analyzed. One hundred thirty-nine (65%) patients were admitted from the emergency department or received physiologically stabilizing treatment in the emergency department. Area Under the Receiver Operating Characteristic Curve (AUROC) for hospital admission was 0.697 and for admission or physiologically stabilizing treatment was 0.710. No patient scoring<2 was admitted or received stabilizing treatment.


CONCLUSIONS
Despite significant over-triage, this system could have diverted 79 patients safely from the emergency department to alternative, unscheduled, care providers.
Challen
Kirsty
K
Health Services Research, University of Sheffield, Emergency Department, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK. kirstychallen@hotmail.com
Walter
Darren
D
D000552:Ambulances; D000554:Ambulatory Care Facilities; D003657:Decision Making; D004417:Dyspnea / Q000175:diagnosis* / Q000209:etiology; D004636:Emergency Service, Hospital; D006801:Humans; D010343:Patient Admission; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014218:Triage / Q000379:methods* / Q000592:standards; D006113:United Kingdom