title: Can emergency care practitioners differentiate between an avoided emergency department attendance and an avoided admission?
abstract: BACKGROUND
  After a 999 call to the ambulance service, there is no 'gold standard' for determining whether the actions of an emergency care practitioner (ECP) result in a patient avoiding attendance at an emergency department (ED) or avoiding an admission to hospital. Within the Great Western Ambulance Service NHS Trust this outcome has previously been measured using an audit form completed by the ECP. However, the accuracy of the ECP's opinion has not been assessed.
  
  
  OBJECTIVE
  To evaluate the accuracy of the ECP's opinion when deciding whether their actions resulted in a patient avoiding attendance at an ED or avoiding hospital admission.
  
  
  METHODS
  Over a 10-week-period in 2009, quantitative data were collected using a case review approach. Anonymised patient consultation records were independently reviewed by an ED consultant and a general practitioner. The decision as to whether the actions of the ECP resulted in the patient avoiding ED attendance or hospital admission was compared between the three healthcare professionals using descriptive statistics and κ values to assess inter-rater agreement.
  
  
  RESULTS
  Overall inter-rater agreement between the three healthcare professionals was κ=0.385 (fair agreement). The complete agreement rate on a case by case basis for all three healthcare professionals was 80.2% (138/172).
  
  
  CONCLUSIONS
  This study provides some evidence that ECPs can accurately report on whether their actions, at the time of that care episode, result in a patient avoiding attendance at an ED or avoiding a hospital admission.
authors.affiliation: Clinical Directorate, Great Western Ambulance Service NHS Trust, Chippenham, Wiltshire, UK. david.coates@gwas.nhs.uk
authors.forename: David
authors.initials: D
authors.lastname: Coates
authors.forename: Steven
authors.initials: S
authors.lastname: Rawstorne
authors.forename: Jonathan
authors.initials: J
authors.lastname: Benger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D004632:Emergency Medical Services / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004739:England; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*