• J Am Geriatr Soc · Jul 2014

    Randomized Controlled Trial

    Randomized controlled trial of a prehospital decision system by emergency medical services to ensure optimal treatment for older adults in Sweden.

    • Veronica Vicente, Leif Svensson, Birgitta Wireklint Sundström, Fredrik Sjöstrand, and Maaret Castren.
    • Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden; Section of Emergency Medicine, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
    • J Am Geriatr Soc. 2014 Jul 1;62(7):1281-7.

    ObjectivesTo evaluate the feasibility and appropriateness of a prehospital system allowing ambulance nurses to transport older adults directly to geriatric care at a community-based hospital (CH) or to an emergency department (ED).DesignRandomized controlled trial.SettingEmergency medical services in Stockholm, Sweden.ParticipantsOlder adults who called the emergency number were randomized to an intervention group (n = 410) or a control group (n = 396).InterventionThe dispatcher randomized the individuals. Those randomized to the intervention group were transported to several alternative destinations decided by a trained nurse performing a comprehensive assessment, using the new prehospital system. Those randomized to the control group were transported to the ED.MeasurementsPrimary endpoint: number of individuals triaged directly to a CH (feasibility). Secondary endpoint: number of subsequent transfers (appropriateness) from CH to ED within 24 hours after initial admission.ResultsAfter exclusion and crossover, the control group consisted of 217 and the intervention group of 449 older adults. The nurse sent 20% of the intervention group (90/449) (95% confidence interval (CI) = 16.6-24.0) directly to the CH when using the prehospital system. Six of those individuals (6.7%) (95% CI = 3.1-13.8) were subsequently transferred from the CH to the ED. Overall, the nurse appropriately triaged 93.3% of the participants (84/90) and transferred them to the CH, avoiding an ED visit.ConclusionAmbulance nurses are able to send older adults to an alternative healthcare facility with the help of a prehospital decision support system. In this geographical setting, this appears to be a promising method to optimize resources and improve emergency care of elderly adults.© 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

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