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dc.contributor.authorNewton, Mark
dc.contributor.authorTunn, Eddie
dc.contributor.authorMoses, Ian
dc.contributor.authorRatcliffe, David
dc.contributor.authorMackway-Jones, Kevin C.
dc.date.accessioned2019-11-06T09:58:58Z
dc.date.available2019-11-06T09:58:58Z
dc.date.issued2014-10
dc.identifier.citationNewton, M. et al, 2014. Clinical navigation for beginners: the clinical utility and safety of the Paramedic Pathfinder. Emergency Medicine Journal : EMJ, 31 (e1), e29-e34.en_US
dc.identifier.issn1472-0205
dc.identifier.issn1472-0213
dc.identifier.doi10.1136/emermed-2012-202033
dc.identifier.urihttp://hdl.handle.net/20.500.12417/403
dc.description.abstractBackground English Ambulance Services are faced with annual increases in emergency demand. Addressing the demand for low acuity emergency calls relies upon the ability of ambulance clinicians to accurately identify the most appropriate destination or referral pathway. Given the risk of undertriage, the challenge is to develop processes that can safely determine patient dispositions, thereby increasing the number of patients receiving care closer to home. Aims The aim of the study was to evaluate the clinical utility and safety of triage support tools (Paramedic Pathfinders). Methods Two triage filters (Pathfinders) were developed (one medical, one trauma). These were applied by ambulance clinicians to 481 patients who had been transported to emergency departments (EDs). Preferred (gold standard) patient dispositions were established by senior medical practitioners using both ambulance and ED clinical records. The clinical utility of ambulance clinicians using Pathfinders was evaluated against this gold standard. Results The Medical Pathfinder was applied to 367 patients (76.3%) and the Trauma Pathfinder to 114 (23.7%). Agreement between ambulance clinician and gold standard was achieved in 387 cases (80.5%) giving the tools a combined sensitivity of 94.83% and specificity of 57.9%. 20.9% of medical patients and 30.7% of trauma patients who had been transported to hospital could have been safely cared for elsewhere. Conclusions Ambulance clinicians using Pathfinders have demonstrated acceptable levels of sensitivity in identifying patients who require ED care. The actual impact of the tools in clinical practice will be dependent on the provision of suitable alternatives to ED. https://emj.bmj.com/content/emermed/31/e1/e29.full.pdf 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/ http://dx.doi.org/10.1136/emermed-2012-202033
dc.language.isoenen_US
dc.subjectEmergency Medical Servicesen_US
dc.subjectTriageen_US
dc.subjectClinical Decision-Makingen_US
dc.subjectNeeds Assessmenten_US
dc.subjectCritical Pathwaysen_US
dc.titleClinical navigation for beginners: the clinical utility and safety of the Paramedic Pathfinderen_US
dc.typeJournal Article/Review
dc.source.journaltitleEmergency Medicine Journalen_US
dcterms.dateAccepted2019-10-10
rioxxterms.versionNAen_US
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserveden_US
rioxxterms.licenseref.startdate2019-10-10
refterms.panelUnspecifieden_US
refterms.dateFirstOnline2013-10
html.description.abstractBackground English Ambulance Services are faced with annual increases in emergency demand. Addressing the demand for low acuity emergency calls relies upon the ability of ambulance clinicians to accurately identify the most appropriate destination or referral pathway. Given the risk of undertriage, the challenge is to develop processes that can safely determine patient dispositions, thereby increasing the number of patients receiving care closer to home. Aims The aim of the study was to evaluate the clinical utility and safety of triage support tools (Paramedic Pathfinders). Methods Two triage filters (Pathfinders) were developed (one medical, one trauma). These were applied by ambulance clinicians to 481 patients who had been transported to emergency departments (EDs). Preferred (gold standard) patient dispositions were established by senior medical practitioners using both ambulance and ED clinical records. The clinical utility of ambulance clinicians using Pathfinders was evaluated against this gold standard. Results The Medical Pathfinder was applied to 367 patients (76.3%) and the Trauma Pathfinder to 114 (23.7%). Agreement between ambulance clinician and gold standard was achieved in 387 cases (80.5%) giving the tools a combined sensitivity of 94.83% and specificity of 57.9%. 20.9% of medical patients and 30.7% of trauma patients who had been transported to hospital could have been safely cared for elsewhere. Conclusions Ambulance clinicians using Pathfinders have demonstrated acceptable levels of sensitivity in identifying patients who require ED care. The actual impact of the tools in clinical practice will be dependent on the provision of suitable alternatives to ED. https://emj.bmj.com/content/emermed/31/e1/e29.full.pdf 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/ http://dx.doi.org/10.1136/emermed-2012-202033en_US


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