title: An evaluation of a new prehospital pre-alert guidance tool.
abstract: BACKGROUND
  The requirement for guidance regarding ambulance crews pre-alerting patients into hospital emergency departments (ED) has been well established, but a clear guidance tool that supports a decision to pre-alert a receiving hospital is lacking.
  
  
  OBJECTIVE
  To investigate the impact of a new pre-alert tool on current alerting practice and evaluate its ability to take the place of a prehospital early warning system.
  
  
  METHODS
  Data were collected for a sample of patients brought by ambulance to the resuscitation area of Aberdeen Royal Infirmary ED over a 7-week period. Basic demographic information plus alert status and guidance prompt status was collected and compared with a pragmatic alert requirement. Analysis of ambulance crew alert decisions and the pre-alert guidance prompt advice was undertaken and compared.
  
  
  RESULTS
  Ambulance crew decisions to alert had a sensitivity of 72% (CI 62% to 80%), specificity of 50% (CI 27% to 73%), positive predictive value (PPV) of 90% and negative predictive value (NPV) of 22%. The pre-alert guidance alert prompt had a sensitivity of 99% (CI 94% to 100%), specificity of 64% (CI 39% to 84%), PPV of 95% and NPV of 90%. 28% of patients were under-alerted by ambulance crews, mostly medical patients presenting with chest pain.
  
  
  CONCLUSIONS
  The pre-alert guidance tool shows face validity and superior ability to advise a pre-alert than ambulance crew decisions. It supplements a practitioners' clinical decision-making and has been regarded as having a positive impact on ED triage and utilisation of resources. Further levels of validity are expected to be achieved with continued audit and ongoing use of this tool.
authors.affiliation: Aberdeen University Medical School, Aberdeen, UK. s.m.booth.07@aberdeen.ac.uk
authors.forename: Sean Michael
authors.initials: SM
authors.lastname: Booth
authors.forename: Mark
authors.initials: M
authors.lastname: Bloch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D003661:Decision Support Techniques; D004631:Emergency Medical Service Communication Systems / Q000592:standards*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012606:Scotland; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: emergency department; paramedics, guidelines; prehospital care