title: Randomized controlled trial of a prehospital decision system by emergency medical services to ensure optimal treatment for older adults in Sweden.
abstract: OBJECTIVE
  To evaluate the feasibility and appropriateness of a prehospital system allowing ambulance nurses to transport older adults directly to geriatric care at a community-based hospital (CH) or to an emergency department (ED).
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Emergency medical services in Stockholm, Sweden.
  
  
  METHODS
  Older adults who called the emergency number were randomized to an intervention group (n = 410) or a control group (n = 396).
  
  
  METHODS
  The dispatcher randomized the individuals. Those randomized to the intervention group were transported to several alternative destinations decided by a trained nurse performing a comprehensive assessment, using the new prehospital system. Those randomized to the control group were transported to the ED.
  
  
  METHODS
  Primary endpoint: number of individuals triaged directly to a CH (feasibility). Secondary endpoint: number of subsequent transfers (appropriateness) from CH to ED within 24 hours after initial admission.
  
  
  RESULTS
  After exclusion and crossover, the control group consisted of 217 and the intervention group of 449 older adults. The nurse sent 20% of the intervention group (90/449) (95% confidence interval (CI) = 16.6-24.0) directly to the CH when using the prehospital system. Six of those individuals (6.7%) (95% CI = 3.1-13.8) were subsequently transferred from the CH to the ED. Overall, the nurse appropriately triaged 93.3% of the participants (84/90) and transferred them to the CH, avoiding an ED visit.
  
  
  CONCLUSIONS
  Ambulance nurses are able to send older adults to an alternative healthcare facility with the help of a prehospital decision support system. In this geographical setting, this appears to be a promising method to optimize resources and improve emergency care of elderly adults.
authors.affiliation: Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden; Section of Emergency Medicine, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
authors.forename: Veronica
authors.initials: V
authors.lastname: Vicente
authors.forename: Leif
authors.initials: L
authors.lastname: Svensson
authors.forename: Birgitta
authors.initials: B
authors.lastname: Wireklint Sundström
authors.forename: Fredrik
authors.initials: F
authors.lastname: Sjöstrand
authors.forename: Maaret
authors.initials: M
authors.lastname: Castren
mesh_terms: D000369:Aged, 80 and over; D004632:Emergency Medical Services; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D013548:Sweden; D014218:Triage
keywords: emergency medical service; older adults; triage