+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

A pathway care model allowing low-risk patients to gain direct admission to a hospital medical ward--a pilot study on ambulance nurses and Emergency Department physicians

A pathway care model allowing low-risk patients to gain direct admission to a hospital medical ward--a pilot study on ambulance nurses and Emergency Department physicians

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 22: 72

A pathway care model allowing low-risk patients to gain rapid admission to a hospital medical ward - a pilot study on ambulance nurses and Emergency Department physicians. Patients with non-urgent medical symptoms who nonetheless require inpatient hospital treatment often have to wait for an unacceptably long time at the Emergency Department (ED). The purpose of this study is to evaluate the feasibility and effect on length of delay of a pathway care model for low-risk patients who have undergone prehospital assessment by an ambulance nurse and ED assessment by a physician within 10 minutes of arrival at the ED. The pilot study comparing two low-risk groups took place in western Sweden from October 2011 until January 2012. The pathway model for low-risk patients was used prospectively in the rapid admission group (N = 51), who were admitted rapidly after being assessed by the nurse on scene and then assessed by the ED physician on ED admission. A retrospectively assembled control group (N = 51) received traditional care at the ED. All p-values are age-adjusted. Patients in the rapid admission group were older (mean age 80 years old) than patients in the control group (mean age 73 years old) (p = 0.02). The median delay from arrival at the patient's side until arrival in a hospital medical ward was 57 minutes for the rapid admission group versus 4 hours 13 minutes for the control group (p < 0.0001). However, the median delay time from the ambulance's arrival at the patient's side until the nurse was free for a new assignment was 77 minutes for the rapid admission group versus 49 minutes for the control group (p < 0.0001). The 30-day mortality rate was 20% for the rapid admission group and only 4% for the control group (p = 0.16). The pathway care model for low-risk patients gaining rapid admission to a hospital medical ward shortened length of delay from the first assessment until arrival at the ward. However, the result was achieved at the cost of an increased workload for the ambulance nurse. Furthermore patients who were rapidly admitted to a hospital ward had a high age level and a high early mortality rate. Patient safety in this new model of fast-track assessment needs to be further evaluated.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 057083420

Download citation: RISBibTeXText

PMID: 25491889

DOI: 10.1186/s13049-014-0072-0

Related references

Evaluations by hospital-ward physicians of patient care management quality for patients hospitalized after an emergency department admission. Revue Medicale de Bruxelles 38(2): 73-78, 2017

Reduction of pre-hospital, ambulance, and hospital coronary death by the pre-hospital emergency cardiac care system: a rationale for training emergency medical technicians, nurses, and physicians. Heart and Lung 3(5): 742-747, 1974

Linking ambulance, emergency department and hospital admission records to examine patient and health service delivery outcomes when opening an additional emergency department: A before and after study. Australasian Emergency Nursing Journal 12(4): 176-177, 2009

Stroke and TIA mimics in patients referred to a neurological emergency department by non-ambulance physicians, ambulance physicians and paramedics. Neurologia i Neurochirurgia Polska 2019, 2019

Helping patients and the emergency department: enhanced patient care and reduced hospital admission rates with a pilot rapid access neurology clinic (RANC). Clinical Medicine 15(Suppl. 3): S10, 2015

Identifying infected emergency department patients admitted to the hospital ward at risk of clinical deterioration and intensive care unit transfer. Academic Emergency Medicine 17(10): 1080-1085, 2011

Indiana's Emergency Medical Services. An open letter to physicians interested in improving pre-hospital (ambulance) patient care. Indiana Medicine 78(10): 898-899, 1985

Hospital admission decision for patients with community-acquired pneumonia: variability among physicians in an emergency department. Annals of Emergency Medicine 59(1): 35-41, 2012

The emergency to home project: impact of an emergency department care coordinator on hospital admission and emergency department utilization among seniors. International Journal of Emergency Medicine 7: 18, 2014

Patient physiological status at the emergency department-ward interface and emergency calls for clinical deterioration during early hospital admission. Journal of Advanced Nursing 72(6): 1287-1300, 2018

Direct Admission Of Stemi Patients To The Cardiac Care Unit Versus Admission Via The Emergency Department For Primary Coronary Intervention Improves Short And Long-Term Survival. Harefuah 158(1): 35-40, 2019

Assessment of prehospital medical care for the patients transported to emergency department by ambulance. Turkish Journal of Emergency Medicine 15(3): 122-125, 2016

An Interdepartmental Care Model to Expedite Admission from the Emergency Department to the Medical ICU. Joint Commission Journal on Quality and Patient Safety 41(12): 542-549, 2016

Emergency admission of elderly patients to a medical ward in the municipality of Copenhagen. II. Social medical conditions prior to admission. Ugeskrift for Laeger 141(30): 2075-2078, 1979

The effect on hospital admission profiles of establishing an emergency department observation ward. Medical Journal of Australia 173(8): 411-414, 2000