Can emergency care practitioners differentiate between an avoided emergency department attendance and an avoided admission?

Abstract

Background: After a 999 call to the ambulance service, there is no 'gold standard' for determining whether the actions of an emergency care practitioner (ECP) result in a patient avoiding attendance at an emergency department (ED) or avoiding an admission to hospital. Within the Great Western Ambulance Service NHS Trust this outcome has previously been measured using an audit form completed by the ECP. However, the accuracy of the ECP's opinion has not been assessed. Aim: To evaluate the accuracy of the ECP's opinion when deciding whether their actions resulted in a patient avoiding attendance at an ED or avoiding hospital admission. Methods: Over a 10-week-period in 2009, quantitative data were collected using a case review approach. Anonymised patient consultation records were independently reviewed by an ED consultant and a general practitioner. The decision as to whether the actions of the ECP resulted in the patient avoiding ED attendance or hospital admission was compared between the three healthcare professionals using descriptive statistics and κ values to assess inter-rater agreement. Results: Overall inter-rater agreement between the three healthcare professionals was κ=0.385 (fair agreement). The complete agreement rate on a case by case basis for all three healthcare professionals was 80.2% (138/172). Conclusion: This study provides some evidence that ECPs can accurately report on whether their actions, at the time of that care episode, result in a patient avoiding attendance at an ED or avoiding a hospital admission. https://emj.bmj.com/content/29/10/838.long. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/emermed-2011-200484