Ambulance Service of New South Wales – Low Risk Patients
This was a literature review project undertaken by the CHSD to ‘Review the Capacity of the Paramedic to Identify the Low Risk Patient’, for the Ambulance Service of New South Wales (ASNSW). It covered the evidence on how paramedics identify low risk patients using risk identification/triage methodologies, where ‘low risk’ meant an ambulance would be required within 90 minutes of the call.
The initial step was to describe the ‘patient journey’ for a caller to the ASNSW in order to focus the literature search. A classification system, designed by the CHSD, based on hierarchies of evidence originally developed by other organisations, was used to assess the strength of the evidence in the literature. This resulted in a practical framework to present the results of the review:
- Understanding the risk identification/triage capacity of emergency department (ED) personnel
- Comparing the risk identification/triage capacity of paramedics
- Validation methods used with paramedic decision-making processes for low risk patients
- Alternative interventions/models of care for management of low risk patients
- Barriers and enablers to the acceptance of paramedic patient assessment decisions
There was no current ‘standard’ for assessing patient risk, however the inter-rater reliability of the Australian Triage Scale (ATS), could be used to compare the ratings of paramedics to ratings by ED staff, or to other tools, using written scenarios, ‘real time’ categorisation, retrospective review and comparison with guidelines.
Most of the models/interventions in the literature were not supported by good quality research evidence, mostly because the relevant research had not been done. As a result, the recommendations of the project were for targeted research to answer the key questions identified during the project.
Download the final report:
Thompson C, Masso M, Westera A, Morris and Eagar K (2011) Ambulance Service of NSW: Review the Capacity of the Paramedic to Identify the Low Risk Patient Final Report. Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong.