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SMJ // Article

Original Article

Two Types of Prehospital Systems Interventions that Triage Low-Acuity Patients to Alternative Sites of Care

Authors: Kurt Krumperman, PhD, NRP, Steven Weiss, MD, Lynne Fullerton, PhD

Abstract

Objectives: 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.

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