ArticleBritish paramedic journal2019
Using vignettes to assess the accuracy and rationale of paramedic decisions on conveyance to the emergency department.
Article in British paramedic journal, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
6 citing papers in PubMed, 9 citations in OpenAlex.
- An innovative care model for urgent and emergency care: A qualitative evaluation of community unscheduled care co-ordination hubs.PloS one · 2026Article
- Paramedic recognition of posterior circulation stroke: a vignette and focus group study.British paramedic journal · 2023Article
- Rethinking non-urgent EMS conveyance to ED during night-time - a pilot study in Southwest Finland.BMC emergency medicine · 2023Article
- Article
- The Safety INdEx of Prehospital On Scene Triage (SINEPOST) study: the development and validation of a risk prediction model to support ambulance clinical transport decisions on-scene-a protocol.Diagnostic and prognostic research · 2021Article
- Alternatives to direct emergency department conveyance of ambulance patients: a scoping review of the evidence.Scandinavian journal of trauma, resuscitation and emergency medicine · 2021Article
Corrections and comments
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Authors and funding
3 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionParamedics make important decisions about whether a patient needs transport to hospital, or can be discharged on scene. These decisions require a degree of accuracy, as taking low acuity patients to the emergency department (ED) can support ambulance ramping. In contrast, leaving mid-high acuity patients on scene can lead to incidents and recontact. This study aims to investigate the accuracy of conveyance decisions made by paramedics when looking at real life patient scenarios with known outcomes. It also aims to explore how the paramedic made the decision.
methodsWe undertook a prospective mixed method triangulation design. Six individual patient vignettes were created using linked ambulance and ED data. These were then presented in an online survey to paramedics in Yorkshire. Half the vignettes related to mid-high acuity attendances at the ED and the other half were low acuity. Vignettes were validated by a small expert panel. Participants were asked to determine the appropriate conveyance decision and to explain the rationale behind their decisions using a free-text box.
resultsA total of 143 paramedics undertook the survey and 858 vignettes were completed. There was clear agreement between paramedics for transport decisions (ƙ = 0.63). Overall accuracy was 0.69 (95% CI 0.66-0.73). Paramedics were better at 'ruling in' the ED, with sensitivity of 0.89 (95% CI 0.86-0.92). The specificity of 'ruling out' the ED was 0.51 (95% CI 0.46-0.56). Text comments were focused on patient safety and risk aversion. DISCUSSION: Paramedics make accurate conveyance decisions but are more likely to over-convey than under-convey, meaning that while decisions are safe they are not always appropriate. It is important that paramedics feel supported by the service to make safe and confident non-conveyance decisions. Reducing over-conveyance is a potential method of reducing demand in the urgent and emergency care system.
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