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Results of an evaluation of the effectiveness of triage and direct transportation to minor injuries units by ambulance crews
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  1. H Snooks1,
  2. T Foster2,
  3. J Nicholl3
  1. 1Clinical School, University of Wales Swansea, UK
  2. 2London Ambulance Service NHS Trust, UK
  3. 3Medical Care Research Unit, University of Sheffield, UK
  1. Correspondence to:
 Dr H Snooks
 Clinical School, University of Wales Swansea, Singleton Park, Swansea SA2 8PP, UK; h.a.snooksswan.ac.uk

Abstract

Objective: To evaluate triage and transportation to a minor injury unit (MIU) by emergency ambulance crews.

Methods: Ambulance crews in two services were asked to transport appropriate patients to MIU during randomly selected weeks of one year. During all other weeks they were to treat such patients according to normal practice. Patients were followed up through ambulance service, hospital and/or MIU records, and by postal questionnaire. Semi-structured interviews were undertaken with crews (n = 15). Cases transferred from MIU to accident and emergency (A&E) were reviewed.

Results: 41 intervention cluster patients attended MIU, 303 attended A&E, 65 were not conveyed. Thirty seven control cluster patients attended MIU, 327 attended A&E, 61 stayed at scene. Because of low study design compliance, outcomes of patients taken to MIU were compared with those taken to A&E, adjusted for case mix. MIU patients were 7.2 times as likely to rate their care as excellent (95% CI 1.99 to 25.8). Ambulance service job-cycle time and time in unit were shorter for MIU patients (−7.8, 95% CI −11.5 to −4.1); (−222.7, 95%CI −331.9 to −123.5). Crews cited patient and operational factors as inhibiting MIU use; and location, service, patient choice, job-cycle time, and handover as encouraging their use. Of seven patients transferred by ambulance from MIU to A&E, medical reviewers judged that three had not met the protocol for conveyance to MIU. No patients were judged to have suffered adverse consequences.

Conclusions: MIUs were only used for a small proportion of eligible patients. When they were used, patients and the ambulance service benefited.

  • minor injuries units
  • ambulance
  • emergency care
  • evaluation
  • triage
  • MIU, minor injury unit
  • SAS, Surrey Ambulance Service
  • LAS, London Ambulance Service
  • A&E, accident and emergency
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Footnotes

  • Funding: the study was funded by London Region NHS Executive.

  • Conflicts of interest: none declared.

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