title: A pathway care model allowing low-risk patients to gain direct admission to a hospital medical ward--a pilot study on ambulance nurses and Emergency Department physicians.
abstract: A pathway care model allowing low-risk patients to gain rapid admission to a hospital medical ward - a pilot study on ambulance nurses and Emergency Department physicians.
  
  
  BACKGROUND
  Patients with non-urgent medical symptoms who nonetheless require inpatient hospital treatment often have to wait for an unacceptably long time at the Emergency Department (ED). The purpose of this study is to evaluate the feasibility and effect on length of delay of a pathway care model for low-risk patients who have undergone prehospital assessment by an ambulance nurse and ED assessment by a physician within 10 minutes of arrival at the ED.
  
  
  METHODS
  The pilot study comparing two low-risk groups took place in western Sweden from October 2011 until January 2012. The pathway model for low-risk patients was used prospectively in the rapid admission group (N = 51), who were admitted rapidly after being assessed by the nurse on scene and then assessed by the ED physician on ED admission. A retrospectively assembled control group (N = 51) received traditional care at the ED. All p-values are age-adjusted.
  
  
  RESULTS
  Patients in the rapid admission group were older (mean age 80 years old) than patients in the control group (mean age 73 years old) (p = 0.02). The median delay from arrival at the patient's side until arrival in a hospital medical ward was 57 minutes for the rapid admission group versus 4 hours 13 minutes for the control group (p < 0.0001). However, the median delay time from the ambulance's arrival at the patient's side until the nurse was free for a new assignment was 77 minutes for the rapid admission group versus 49 minutes for the control group (p < 0.0001). The 30-day mortality rate was 20% for the rapid admission group and only 4% for the control group (p = 0.16).
  
  
  CONCLUSIONS
  The pathway care model for low-risk patients gaining rapid admission to a hospital medical ward shortened length of delay from the first assessment until arrival at the ward. However, the result was achieved at the cost of an increased workload for the ambulance nurse. Furthermore patients who were rapidly admitted to a hospital ward had a high age level and a high early mortality rate. Patient safety in this new model of fast-track assessment needs to be further evaluated.
authors.affiliation: School of Health Sciences, Research Centre PreHospen, University of Borås, The Prehospital Research Centre of Western Sweden, SE-501 90, Borås, Sweden. birgitta.wireklint.sundstrom@hb.se.
authors.forename: Birgitta
authors.initials: B
authors.lastname: Wireklint Sundström
authors.affiliation: Gothenburg EMS System, Sahlgrenska Academy and University Hospital, Gothenburg, Sweden. emsansa@hotmail.com.
authors.forename: Emelie
authors.initials: E
authors.lastname: Petersson
authors.affiliation: Gothenburg EMS System, Sahlgrenska Academy and University Hospital, Gothenburg, Sweden. sjoholm66@hotmail.com.
authors.forename: Marcus
authors.initials: M
authors.lastname: Sjöholm
authors.affiliation: Gothenburg EMS System, Sahlgrenska Academy and University Hospital, Gothenburg, Sweden. carita.gelang@vgregion.se.
authors.forename: Carita
authors.initials: C
authors.lastname: Gelang
authors.affiliation: School of Health Sciences, Research Centre PreHospen, University of Borås, The Prehospital Research Centre of Western Sweden, SE-501 90, Borås, Sweden. christer.axelsson@hb.se.|Gothenburg EMS System, Sahlgrenska Academy and University Hospital, Gothenburg, Sweden. christer.axelsson@hb.se.
authors.forename: Christer
authors.initials: C
authors.lastname: Axelsson
authors.affiliation: Department of Public Health and Community Medicine, Sahlgrenska Academy and University Hospital, Gothenburg, Sweden. thomas.karlsson@gu.se.
authors.forename: Thomas
authors.initials: T
authors.lastname: Karlsson
authors.affiliation: School of Health Sciences, Research Centre PreHospen, University of Borås, The Prehospital Research Centre of Western Sweden, SE-501 90, Borås, Sweden. johan.herlitz@hb.se.
authors.forename: Johan
authors.initials: J
authors.lastname: Herlitz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances / Q000458:organization & administration*; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D017146:Models, Organizational; D009726:Nurses / Q000458:organization & administration*; D010343:Patient Admission / Q000706:statistics & numerical data*; D010820:Physicians / Q000458:organization & administration*; D010865:Pilot Projects; D013997:Time Factors; D000078329:Workforce