Mental health emergencies attended by ambulances in the United Kingdom and the implications for health service delivery: A cross-sectional study.

IF 1.9 4区 医学 Q3 HEALTH POLICY & SERVICES
Harriet Elizabeth Moore, Aloysius Niroshan Siriwardena, Mark Gussy, Robert Spaight
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引用次数: 1

Abstract

Objective: In the context of increasing demand for ambulance services, emergency mental health cases are among the most difficult for ambulance clinicians to attend, partly because the cases often involve referring patients to other services. We describe the characteristics of mental health emergencies in the East Midlands region of the United Kingdom. We explore the association between 999 (i.e. emergency) call records, the clinical impressions of ambulance clinicians attending emergencies and the outcomes of ambulance attendance. We consider the implications of our results for optimizing patient care and ambulance service delivery.

Methods: We conducted a retrospective observational study of records of all patients experiencing mental health emergencies attended by ambulances between 1 January 2018 and 31 July 2020. The records comprised details of 103,801 '999' calls (Dispatch), the preliminary diagnoses by ambulance clinicians on-scene (Primary Clinical Impression) and the outcomes of ambulance attendance for patients (Outcome).

Results: A multinomial regression analysis found that model fit with Outcome data was improved with the addition of Dispatch and Primary Clinical Impression categories compared to the fit for the model containing only the intercept and Outcome categories (Chi-square = 18,357.56, df = 180, p < 0.01). Dispatch was a poor predictor of Primary Clinical impression. The most common predictors of Outcome care pathways other than 'Treated and transported' were records of respiratory conditions at Dispatch and anxiety reported by clinicians on-scene.

Conclusions: Drawing on the expertise of mental health specialists may help '999' dispatchers distinguish between physical and mental health emergencies and refer patients to appropriate services earlier in the response cycle. Further investigation is needed to determine if training Dispatch operatives for early triage and referral can be appropriately managed without compromising patient safety.

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英国救护车参与的精神卫生紧急情况及其对卫生服务提供的影响:一项横断面研究。
目的:在对救护车服务需求不断增加的背景下,紧急精神卫生案件是救护车临床医生最难参加的案件之一,部分原因是这些案件往往涉及将患者转介到其他服务。我们描述了英国东米德兰兹地区精神卫生紧急情况的特点。我们探索999(即紧急)呼叫记录之间的关联,救护车临床医生参加紧急情况的临床印象和救护车出勤的结果。我们考虑我们的结果对优化病人护理和救护车服务交付的影响。方法:我们对2018年1月1日至2020年7月31日期间救护车救护的所有精神卫生急诊患者的记录进行了回顾性观察研究。这些记录包括103,801次999呼叫的详细信息(调度),现场救护车临床医生的初步诊断(初步临床印象)和救护车对患者的护理结果(结果)。结果:多项回归分析发现,与只包含截距和结果类别的模型相比,加入分派和主要临床印象类别的模型与结果数据的拟合得到了改善(卡方= 18,357.56,df = 180, p < 0.01)。调度是一个较差的预测主要临床印象。除“治疗和转运”外,结果护理途径最常见的预测因素是调度时的呼吸条件记录和现场临床医生报告的焦虑。结论:利用心理健康专家的专业知识可以帮助“999”调度员区分身体和精神健康紧急情况,并在响应周期的早期将患者转介到适当的服务。需要进一步调查,以确定培训调度人员进行早期分诊和转诊是否可以在不损害患者安全的情况下得到适当管理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.40
自引率
4.20%
发文量
39
期刊介绍: Journal of Health Services Research & Policy provides a unique opportunity to explore the ideas, policies and decisions shaping health services throughout the world. Edited and peer-reviewed by experts in the field and with a high academic standard and multidisciplinary approach, readers will gain a greater understanding of the current issues in healthcare policy and research. The journal"s strong international editorial advisory board also ensures that readers obtain a truly global and insightful perspective.
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