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An evaluation of a new prehospital pre-alert guidance tool
  1. Sean Michael Booth1,
  2. Mark Bloch2
  1. 1Aberdeen University Medical School, Aberdeen, UK
  2. 2Department of Anaesthesia, Aberdeen Royal Infirmary and University of Aberdeen, Aberdeen, UK
  1. Correspondence to Sean Michael Booth, Aberdeen University Medical School, The Suttie Centre, Foresterhill, Aberdeen, AB25 2ZD; s.m.booth.07{at}


Background The requirement for guidance regarding ambulance crews pre-alerting patients into hospital emergency departments (ED) has been well established, but a clear guidance tool that supports a decision to pre-alert a receiving hospital is lacking.

Aims To investigate the impact of a new pre-alert tool on current alerting practice and evaluate its ability to take the place of a prehospital early warning system.

Methods Data were collected for a sample of patients brought by ambulance to the resuscitation area of Aberdeen Royal Infirmary ED over a 7-week period. Basic demographic information plus alert status and guidance prompt status was collected and compared with a pragmatic alert requirement. Analysis of ambulance crew alert decisions and the pre-alert guidance prompt advice was undertaken and compared.

Results Ambulance crew decisions to alert had a sensitivity of 72% (CI 62% to 80%), specificity of 50% (CI 27% to 73%), positive predictive value (PPV) of 90% and negative predictive value (NPV) of 22%. The pre-alert guidance alert prompt had a sensitivity of 99% (CI 94% to 100%), specificity of 64% (CI 39% to 84%), PPV of 95% and NPV of 90%. 28% of patients were under-alerted by ambulance crews, mostly medical patients presenting with chest pain.

Conclusions The pre-alert guidance tool shows face validity and superior ability to advise a pre-alert than ambulance crew decisions. It supplements a practitioners’ clinical decision-making and has been regarded as having a positive impact on ED triage and utilisation of resources. Further levels of validity are expected to be achieved with continued audit and ongoing use of this tool.

  • emergency department
  • prehospital care
  • paramedics, guidelines

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