Safety and compliance with an emergency medical service direct psychiatric center transport protocol

      Abstract

      Objectives

      To evaluate compliance and safety of an emergency medical service (EMS) triage protocol that allows paramedics to transport patients directly to psychiatric emergency services.

      Methods

      A psychiatric patient diversion protocol was developed for our system. Protocol compliance was evaluated the following 3 ways: (1) psychiatric facility intake forms completed by mental health workers on patients transported by EMS directly to a psychiatric emergency service (PES) bypassing the ED, (2) hospital records for patients who were redirected from PES to the ED for medical evaluation, (3) retrospective analysis of ambulance charts. Study outcomes included protocol noncompliance rate, protocol failure rate, and any morbidity associated with either noncompliance or protocol failure. Data were analyzed using proportions and 95% confidence intervals (CI).

      Results

      A total of 174 patients were directly transported to PES bypassing ED medical clearance. The protocol effectively screened for medical issues in 96% of cases. Protocol noncompliance occurred in 51 cases for a frequency of 29% (CI, 22%-36%). One patient in the paramedic noncompliance group required hospital admission. There was protocol failure in 5 (2.9%; 95% CI, 0.9-6.6) of the patients who fit all protocol requirements for transport to PES but required secondary transport to the ED. All were subsequently transferred back to PES. Nine patients (5.2%; CI, 2.7%-9.5%) required secondary transfer to the ED. No patient had critical or life-threatening problems.

      Conclusions

      Emergency medical service providers showed a poor level of compliance with vital sign criteria, but the protocol provided a high level of safety.
      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Schmidt T.
        • Neely K.W.
        • Adams A.L.
        • Newgard C.D.
        • Wittwer L.
        • Muhr M.
        • et al.
        Is it possible to safely triage callers to EMS dispatch centers to alternative resources?.
        Prehosp Emerg Care. 2003; 7: 368-374
        • Schaefer R.A.
        • Rea T.D.
        • Plorde M.
        • Peiguss K.
        • Goldberg P.
        • Murray J.A.
        An emergency medical services program of alternate destination of patient care.
        Prehosp Emerg Care. 2002; 6: 309-314
        • Korn C.S.
        • Currier G.W.
        • Henderson S.O.
        “Medical clearance” of psychiatric patients without medical complaints in the emergency department.
        J Emerg Med. 2000; 18: 173-176
        • Pointer J.E.
        • Levitt M.A.
        • Young J.C.
        • Promes S.B.
        • Messana B.J.
        • Ader M.E.
        Can paramedics using guidelines accurately triage patients?.
        Ann Emerg Med. 2001; 38: 268-277
        • Reeves R.R.
        • Pendarvis E.J.
        • Kimble R.
        Unrecognized medical emergencies admitted to psychiatric units.
        Am J Emerg Med. 2000; 18: 390-393
        • Silvestri S.
        • Rothrock S.G.
        • Kennedy D.
        • Ladde J.
        • Bryant M.
        • Pagane J.
        Can paramedics accurately identify patients who do not require emergency department care?.
        Prehosp Emerg Care. 2002; 6: 387-390
        • Hauswald M.
        Can paramedics safely decide which patients do not need ambulance transport or emergency department care?.
        Prehosp Emerg Care. 2002; 6: 383-386
        • Broderick K.B.
        • Lerner E.B.
        • McCourt J.D.
        • Fraser E.
        • Salerno K.
        Emergency physician practices and requirements regarding the medical screening examination of psychiatric patients.
        Acad Emerg Med. 2002; 9: 88-92
        • Olshaker J.S.
        • Browne B.
        • Jerrard D.A.
        • Prendergast H.
        • Stair T.O.
        Medical clearance and screening of psychiatric patients in the emergency department.
        Acad Emerg Med. 1997; 4: 124-128
        • Williams E.R.
        • Shepherd S.M.
        Medical clearance of psychiatric patients.
        Emerg Med Clin North Am. 2000; 18: 185,vii-198,vii
        • Tintinalli J.E.
        • Peacock IV, F.W.
        • Wright M.A.
        Emergency medical evaluation of psychiatric patients.
        Ann Emerg Med. 1994; 23: 859-862
        • Zun L.S.
        Evidence-based evaluation of psychiatric patients.
        J Emerg Med. 2005; 28: 35-39
        • Zun L.S.
        • Hernandez R.
        • Thompson R.
        • Downey L.
        Comparison of EPs' and psychiatrists' laboratory assessment of psychiatric patients.
        Am J Emerg Med. 2004; 22: 175-180
        • Zun L.S.
        • Leikin J.B.
        • Stotland N.L.
        • Blade L.
        • Marks R.C.
        A tool for the emergency medicine evaluation of psychiatric patients.
        Am J Emerg Med. 1996; 14: 329-333
        • Gold I.
        • Baraff L.J.
        Psychiatric screening in the emergency department: its effect on physician behavior.
        Ann Emerg Med. 1989; 18: 875-880
        • Henneman P.L.
        • Mendoza R.
        • Lewis R.J.
        Prospective evaluation of emergency department medical clearance.
        Ann Emerg Med. 1994; 24: 672-677
        • Gaddis G.M.
        Improving the design of the assessment of emergency department patients at risk for self-harm.
        Ann Emerg Med. 2006; 48: 467-469
        • Bessman E.S.
        • Michocki R.
        Evaluation of routine screening physicals by emergency room personnel for an alcohol rehabilitation program.
        QRB Qual Rev Bull. 1985; 11: 275-276
        • Davis E.A.
        • Thompson B.
        Emergency Medical Services Field Triage Protocols Accurately identify Patients for Direct Psychiatric Referral.
        Ann Emerg Med. 2002; 40: S54