Identifying patient characteristics associated with potentially redirectable paramedic transported emergency department visits in Ontario, Canada: a population-based cohort study.

Ryan P Strum, Walter Tavares, Andrew Worster, Lauren E Griffith, Andrew P Costa

Abstract readObservational Study

In one paragraph

Observational study in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it

0cells of the map it votes in

7citing papers in PubMed

–field-weighted citation impact

1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed.

Validating the Emergency Department Avoidability Classification (EDAC): A cluster randomized single-blinded agreement study.PloS one · 2024
Trial
Characteristics of 9-1-1 Calls Associated with an Increased Risk of Violence Against Paramedics in a Single Canadian Site.Healthcare (Basel, Switzerland) · 2025
Article
Preterm births prevalence during the COVID-19 pandemic in Brazil: results from the national database.Scientific reports · 2023
Article
Evaluating emergency department transfers from urgent care centres: insights for paramedic integration with subacute healthcare.BMJ open quality · 2023
Article
Prehospital prediction of hospital admission for emergent acuity patients transported by paramedics: A population-based cohort study using machine learning.PloS one · 2023
Article
Validation of a classification to identify emergency department visits suitable for subacute and virtual care models: a randomised single-blinded agreement study protocol.BMJ open · 2022
Article
Increased demand for paramedic transports to the emergency department in Ontario, Canada: a population-level descriptive study from 2010 to 2019.CJEM · 2022
Article

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Ryan P StrumHealth Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada strumr@mcmaster.ca.ORCID 0000-0003-1902-4734

Walter TavaresThe Wilson Centre and Post MD Education, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada.

Andrew WorsterHealth Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.

Lauren E GriffithHealth Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.ORCID 0000-0002-2794-9692

Andrew P CostaHealth Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.ORCID 0000-0001-9212-5641

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveParamedic redirection from emergency department (ED) to subacute centres may be more beneficial for some patients, though little is known about which patients are potentially appropriate. We examined whether patient characteristics were associated with ED visits when the main intervention was suitable to be performed in a subacute centre.

methodsWe conducted a retrospective observational study using the National Ambulatory Care Reporting System from 2014 to 2018 in Ontario, Canada. We included all adult patients transported by paramedics and had a main physician intervention recorded. We used results of a RAND/UCLA modified Delphi study to categorise patients into either ED or a subacute care (urgent care and/or general practice centre) based on their main intervention. An independent logistic regression model was analysed for each subacute centre.

resultsA total of 2 394 072 ED visits were included; 59% of ED interventions were categorised as 'urgent care', 27% 'ED only', 9% either 'urgent care' or 'general practice' and 5% had an intervention not previously classified. ED visits suitable for 'general practice' had the highest percentage of patients discharged, while 'ED only' had the lowest. Lower medical acuity, younger age, time of triage in evening and overnight, and discharged from ED were independently associated with both subacute centres. 'Urgent care' visits/interventions were associated with an ED main diagnosis of the respiratory system (OR 3.49), while 'general practice' visits were associated with mental health disorders (OR 9.85) and injury/poison/consequences of external causes (OR 3.38).

conclusionsThe majority of ED visits had a main intervention that could have potentially been conducted in a subacute centre. We identified characteristics and diagnostic patterns associated with ED visits when the main intervention was categorised as a subacute centre intervention. This study contributes knowledge to inform which patients are potentially appropriate for paramedic redirection.

Indexed as

Allied Health PersonnelEmergency Service, HospitalAdultCohort StudiesHumansOntarioTriageepidemiologyprimary carestatistics & research methods

Identifiers

PMID35225823

DOI10.1136/bmjopen-2021-054625

PMCPMC8718420

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LicenceCC BY-NC

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.