Abstract
The Region of Southern Denmark is implementing three Prehospital Assessment Units. These are staffed with paramedics who, under the supervision of a physician from the local emergency department, assess and treat acute ill patients on-site as an alternative to ambulance conveyance and hospital visits. The new service is available daily from 8:00 AM to 7:00 PM and activated by the Emergency Medical Dispatch Centre upon request by a healthcare professional or in response to an emergency call (1-1-2).
The aim of this study was 1) to describe activation types and outcomes in terms of conveyance and hospital visits after a visit by the Prehospital Assessment Unit and 2) to investigate healthcare professionals’ experience with the implementation in relation to their sectoral affiliation and job function in municipalities, general practise and hospitals.
Data from the electronic prehospital patient records involving the Prehospital Assessment Units over a six-month period were retrieved and manually classified by the first author.
Assessment of implementation of the new service was done using a Danish translation of the questionnaires: Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM). The questionnaires are designed to assess key aspects of implementation outcomes, evaluating how well stakeholders receive, perceive and find an intervention practically feasible within a specific context.
During the study period, the Prehospital Assessment Units was activated 1,679 times (an average of 9 times per day). Of these, 1,119 (67%) were based on an emergency call, and 481 (29%) were initiated by a healthcare professional. In 61% of activations, conveyance to a hospital was prevented, and hospital visits were avoided in 46%.
Healthcare professionals were generally very positive about the Prehospital Assessment Units, with median scores (IQR) of 5.00 (4.0-5.0), 4.13 (4.0-5.0), and 4.25 (3.8-5.0) on the AIM, IAM, and FIM scales, respectively. When comparing across job functions, experience in current job function, sector, experience with Prehospital Assessment Units, and catchment area, only minor differences were noted. The most positive evaluations were given by the paramedics staffing the Prehospital Assessment Units with median scores (IRQ) from 4.75 to 5.00 (4.0-5.0), while the least positive evaluations were provided by municipal nurses and general practice medical doctors, with median scores (IQR) from 4.00 to 4.50 (3.3-5.0).
The study demonstrates that it is possible to reduce conveyance and hospital visits for acutely ill patients, and that healthcare professionals have a positive experience with the implementation of the new service. However, additional analysis of the data is warranted to investigate differences in outcomes based on types of activation, assessments, and treatments performed. Furthermore, investigation of the duration of each activation and opportunities to increase the number of activations per day should also be a focus of future studies to ensure higher utilization of the service.
The study results have implications for future decisions regarding the use of Prehospital Assessment Units to reduce conveyance and hospital visits and to ensure patients’ access to the right services, at the right time, and in the right place.