title: Two Types of Prehospital Systems Interventions that Triage Low-Acuity Patients to Alternative Sites of Care.
abstract: OBJECTIVE
  This study retrospectively compared alternatives for navigating low-acuity patients in two emergency medical services systems. System A involved a response to every 9-1-1 request with an "evaluate, treat, and refer" process, in which paramedics decided whether patients could be treated on-scene and referred to a primary care provider or urgent care center. System B used a "telephone triage and referral" process, in which callers of low severity were diverted from 9-1-1 to call centers where nurses provided advice and/or a referral to a primary care provider/urgent care center. We hypothesized that systems A and B would differ in terms of the percentage of patients following referral instructions and the percentage of patients who were satisfied with their care.
  
  
  METHODS
  Independent variables were age, sex, and ZIP code. The two outcome measures were whether the patient followed the instructions given and patient satisfaction. χ(2) tests and multivariate logistic regression were used.
  
  
  RESULTS
  Controlling for age, sex, income, and race, patients in system A had a lower likelihood of following instructions (odds ratio 0.31; 95% confidence interval 0.14-0.69). Satisfaction rates were high (>93%) but equivalent.
  
  
  CONCLUSIONS
  The odds were lower that callers in system A would follow instructions. Satisfaction rates suggest that people are willing to accept alternatives to transport to the emergency department and high percentages of patients follow the instructions given.
authors.affiliation: From Albuquerque Ambulance Service, and the Department of Emergency Medicine, University of New Mexico, Albuquerque.
authors.forename: Kurt
authors.initials: K
authors.lastname: Krumperman
authors.affiliation: From Albuquerque Ambulance Service, and the Department of Emergency Medicine, University of New Mexico, Albuquerque.
authors.forename: Steven
authors.initials: S
authors.lastname: Weiss
authors.affiliation: From Albuquerque Ambulance Service, and the Department of Emergency Medicine, University of New Mexico, Albuquerque.
authors.forename: Lynne
authors.initials: L
authors.lastname: Fullerton
mesh_terms: D000293:Adolescent; D000368:Aged; D003266:Continuity of Patient Care / Q000458:organization & administration*; D004630:Emergencies / Q000145:classification*; D004632:Emergency Medical Services / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D033183:Interdisciplinary Communication; D008297:Male; D017146:Models, Organizational; D009516:New Mexico; D017063:Outcome Assessment, Health Care; D062072:Patient Acuity; D062526:Patient Navigation / Q000379:methods / Q000458:organization & administration; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000379:methods; D012017:Referral and Consultation / Q000592:standards*; D019114:Remote Consultation / Q000379:methods / Q000592:standards; D012189:Retrospective Studies; D014218:Triage / Q000379:methods / Q000458:organization & administration