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Clinical navigation for beginners: the clinical utility and safety of the Paramedic Pathfinder
  1. Mark Newton,
  2. Eddie Tunn,
  3. Ian Moses,
  4. David Ratcliffe,
  5. Kevin Mackway-Jones
  1. North West Ambulance Service NHS Trust, Bolton, Greater Manchester, UK
  1. Correspondence to Mark Newton, North West Ambulance Service NHS Trust, Ladybridge Hall, 399 Chorley New Road, Bolton, Greater Manchester BL1 5DD, UK; mark.newton{at}nwas.nhs.uk

Abstract

Background English Ambulance Services are faced with annual increases in emergency demand. Addressing the demand for low acuity emergency calls relies upon the ability of ambulance clinicians to accurately identify the most appropriate destination or referral pathway. Given the risk of undertriage, the challenge is to develop processes that can safely determine patient dispositions, thereby increasing the number of patients receiving care closer to home.

Aims The aim of the study was to evaluate the clinical utility and safety of triage support tools (Paramedic Pathfinders).

Methods Two triage filters (Pathfinders) were developed (one medical, one trauma). These were applied by ambulance clinicians to 481 patients who had been transported to emergency departments (EDs). Preferred (gold standard) patient dispositions were established by senior medical practitioners using both ambulance and ED clinical records. The clinical utility of ambulance clinicians using Pathfinders was evaluated against this gold standard.

Results The Medical Pathfinder was applied to 367 patients (76.3%) and the Trauma Pathfinder to 114 (23.7%). Agreement between ambulance clinician and gold standard was achieved in 387 cases (80.5%) giving the tools a combined sensitivity of 94.83% and specificity of 57.9%. 20.9% of medical patients and 30.7% of trauma patients who had been transported to hospital could have been safely cared for elsewhere.

Conclusions Ambulance clinicians using Pathfinders have demonstrated acceptable levels of sensitivity in identifying patients who require ED care. The actual impact of the tools in clinical practice will be dependent on the provision of suitable alternatives to ED.

  • Triage
  • Guidelines
  • Paramedics
  • Clinical Assessment

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