Paramedic streaming upon arrival in emergency department: A prospective study.

Area of Science:

• Emergency Medicine
• Healthcare Management
• Patient Flow Optimization

Background:

• The role of paramedics in hospital triage and streaming models is underexplored.
• Effective patient flow in emergency departments (EDs) is crucial for timely care.

Purpose of the Study:

• To assess the concordance between paramedic streaming decisions and ED nurse decisions.
• To evaluate the clinical risk associated with discordant streaming decisions.

Main Methods:

• Prospective observational study of 500 ambulance-transported cases.
• Paramedics determined patient destination upon hospital arrival (index test).
• ED nurse streaming decision served as the reference standard; discordant cases were reviewed by an expert panel.

Main Results:

• Overall concordance between paramedic and nurse streaming decisions was 86.4%.
• Highest concordance was observed for patients streamed to resuscitation and general cubicles.
• Of 68 discordant cases, 39 were assigned to a more acute destination by nurses, with 56 deemed of no clinical risk.

Conclusions:

• Paramedics can accurately allocate streaming destinations in the ED with high concordance.
• This pre-hospital streaming decision-making is associated with low clinical risk.
• Proactive allocation of ED destinations by paramedics presents an opportunity to minimize off-load times and enhance patient flow.