title: Early prehospital assessment of non-urgent patients and outcomes at the appropriate level of care: A prospective exploratory study.
abstract: BACKGROUND
  The Ambulance Organization of Sweden provides qualified medical assessment and treatment by ambulance nurses based on patient needs regarding appropriate levels of care. A new model for patients with non-urgent medical conditions has been introduced. The main objective of this study was to examine early prehospital assessment of non-urgent patients, and its impact on the choice of the appropriate level of care.
  
  
  METHODS
  The study design was a 1-year, prospective study, involving an ambulance district in southwestern Sweden with a population of 78,000. Eligible patients were from18years of age, assessed as priority GREEN by Rapid Emergency Triage and Treatment System (RETTS). Ambulance nurses contacted primary care physicians on decisions on whether a patient should be transported to a primary healthcare unit or an A&E. Data was collected from electronic health records from April 2014 to July 2015. A comparison was made with a retrospective control group without consulting a physician concerning the appropriate level of care.
  
  
  RESULTS
  394 patients were included, 184 in the intervention group, and 210 in the control group. There were statistically significant differences in favor of the study group (p<0.001) regarding no transport, or transport and admission to an A&E. The groups did not differ significantly regarding transport to a primary care unit.
  
  
  CONCLUSIONS
  This prehospital assessment model indicates a decrease in ambulance transports to an A&E and admissions to a hospital ward. Collaboration between ambulance nurses and primary physicians affects the decision for the appropriate level of care for patients with a non-urgent condition.
authors.affiliation: Department of Ambulance and Prehospital Care, Region Halland, Sweden; Department of Orthopaedics, Lund University, Sweden. Electronic address: Glenn.larsson@regionhalland.se.
authors.forename: Glenn
authors.initials: G
authors.lastname: Larsson
authors.affiliation: Department of R&D, Region Halland, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Holmén
authors.affiliation: School of Health and Welfare, Halmstad University, Sweden.
authors.forename: Kristina
authors.initials: K
authors.lastname: Ziegert
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D004632:Emergency Medical Services / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000706:statistics & numerical data / Q000639:trends; D009730:Nursing Assessment / Q000379:methods* / Q000706:statistics & numerical data; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data* / Q000639:trends; D012189:Retrospective Studies; D013548:Sweden; D013997:Time Factors; D014218:Triage / Q000379:methods* / Q000706:statistics & numerical data
keywords: Ambulance nurse; Appropriate level of care; Non-urgent patients; Prehospital assessment; Primary care physicians; Rapid emergency triage and treatment system