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An evaluation of nurse triage at the Emergency Medical Dispatch centers in two Swedish counties
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
2017 (English)Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
Abstract [sv]

Sjuksköterskor vid Sjukvårdens Larmcentral (SvLC) i Uppsala och Västmanlands län

hänvisar regelbundet lågakuta patienter som bedöms inte vara i behov av ambulanssjukvård

till alternativa vårdformer. I denna studie kopplades patientdata från SvLC till sjukhusregister

för att identifiera patienter som besökte en akutmottagning inom 72 timmar efter en

hänvisning vid SvLC. Prevalensen av ett antal utfallsmått undersöktes och logistisk

regression användes för att fastställa effekten av ett antal variabler. 20% av hänvisade

inringare besökte en akutmottaging inom 72 timmar. Av dessa fick 57% vård på

specialistnivå och 37% lades in vid en slutenvårdsenhet. 86% av akutmottagningsbesöken

gällde det besvär som patienten kontaktade SvLC för. Äldre patienter hänvisades mindre ofta

till alternativa vårdformer, men löpte större risk att kräva vård på specialistnivå och läggas in

vid sjukhuset till följd av ett akutmottagningsbesök. Samtal med personer som ringde in flera

gånger per månad hänvisades oftare av SvLC än patienter med en kontakt under studiens

lopp, medan patienter som ringt in endast ett fåtal gånger besökte akutmottagningen oftare

och blev där oftare inlagda. Icke-användning av SvLCs beslutsstöd var vanligare bland

hänvisade patienter. Uppdrag som avlsutades utan vidare hänvisning till en annan

sjukvårdsinstans resulterade mindre ofta i ett akutmottagningsbesök. Prevalensen av

akutmottagningsbesök och inläggningar vid sjukhus efter hänvisning liknar nivån som funnits

i andra studier av nordisk prehospital triage. Baserat på resultaten från denna studie föreslås

ett antal kvalitetsutvecklingsprojekt samt framtida studier.

Abstract [en]

Nurses working at the Emergency Medical Dispatch (EMD) centers in the Swedish counties

of Uppsala and Västmanland routinely refer patients determined to not require an ambulance

to non-emergency care. In this study, hospital records were reviewed to match calls to

patients visiting an Emergency Department (ED) within 72 hours of being referred to non-

emergency care by an EMD nurse. The prevalence of a number of outcomes was examined,

and logistic regression models were used to analyze the effects of several variables of

interest. 20% of callers referred to non-emergency medical care visited an ED within 72

hours. Of these, 57% received specialist level care, and 37% were admitted to the hospital.

86% of ED visits were found to be in regards to the condition the patient contacted the EMD

for. Elderly patients were less likely to be referred to non-emergency care, but more likely to

receive specialist care and be admitted. Very frequent callers were more likely to be referred

to non-emergency care, while a moderate rate of contact was associated with increased odds

of ED visitation and hospital admission from the ED. Non-utilization of the EMDs’ decision

support tool was more common among callers referred to non-emergency care. Calls closed

by dispatchers without further referral to other healthcare providers were less likely to result

in an ED visit. The prevalence of ED visitations and admissions found in this study are

similar to those found in other studies of Scandinavian pre-hospital triage, and a number of

possibilities for quality improvement and future studies were identified.

Place, publisher, year, edition, pages
2017. , p. 48
Keywords [en]
Ambulance, Triage, Emergency Medical Dispatch, Emergency Medical Service, Low Acuity
Keywords [sv]
Ambulans, Triage, Sjukvårdens Larmcentral, Akutsjukvård, Hänvisning
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-324317OAI: oai:DiVA.org:uu-324317DiVA, id: diva2:1109583
Educational program
Master Programme in Public Health
Supervisors
Examiners
Available from: 2017-06-15 Created: 2017-06-14 Last updated: 2017-06-15Bibliographically approved

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