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Can emergency care practitioners differentiate between an avoided emergency department attendance and an avoided admission?
  1. David Coates1,
  2. Steven Rawstorne1,
  3. Jonathan Benger2
  1. 1Clinical Directorate Great Western Ambulance Service NHS Trust, Chippenham, UK
  2. 2Department of Emergency Care, University of the West of England, Bristol, UK
  1. Correspondence to David Coates, Clinical Directorate, Great Western Ambulance Service NHS Trust, Jenner House, Langley Park Estate, Chippenham, Wiltshire SN15 1GG, UK; david.coates{at}gwas.nhs.uk

Abstract

Background After a 999 call to the ambulance service, there is no ‘gold standard’ for determining whether the actions of an emergency care practitioner (ECP) result in a patient avoiding attendance at an emergency department (ED) or avoiding an admission to hospital. Within the Great Western Ambulance Service NHS Trust this outcome has previously been measured using an audit form completed by the ECP. However, the accuracy of the ECP's opinion has not been assessed.

Aim To evaluate the accuracy of the ECP's opinion when deciding whether their actions resulted in a patient avoiding attendance at an ED or avoiding hospital admission.

Methods Over a 10-week-period in 2009, quantitative data were collected using a case review approach. Anonymised patient consultation records were independently reviewed by an ED consultant and a general practitioner. The decision as to whether the actions of the ECP resulted in the patient avoiding ED attendance or hospital admission was compared between the three healthcare professionals using descriptive statistics and κ values to assess inter-rater agreement.

Results Overall inter-rater agreement between the three healthcare professionals was κ=0.385 (fair agreement). The complete agreement rate on a case by case basis for all three healthcare professionals was 80.2% (138/172).

Conclusion This study provides some evidence that ECPs can accurately report on whether their actions, at the time of that care episode, result in a patient avoiding attendance at an ED or avoiding a hospital admission.

  • Emergency ambulance systems
  • admission avoidance
  • advanced practitioner
  • extended roles
  • emergency care systems
  • advanced practitioner
  • paramedics
  • prehospital care

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Footnotes

  • Competing interests None.

  • Patient consent University of the West of England approved participant consent form used for study. No patient consent was required.

  • Ethics approval North Somerset & South Bristol Research Ethics Committee advised that the project was considered 'service evaluation' and did not require ethical approval (REC reference number 09/H0106/33).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The authors are happy to share data. Correspondence author is happy to receive direct requests.

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