Stakeholder opinion on the proposal to introduce \u2018treat and referral\u2019 into the Irish emergency medical service

Brian Power,John Ryan,Gerard Bury

doi:10.1186/s12873-019-0295-5

Abstract

BackgroundThe Irish ambulance services have traditionally transported all patients following an emergency (112/999) call, regardless of acuity, to an emergency department (ED). A proposal to introduce Treat and Referral, an established care pathway in some jurisdictions, is under active consideration in Ireland. This will present a significant change. Stakeholder engagement is recognised as an essential component of management of such change. This study has conducted a multicentre, cross-sectional survey exploring opinions on the introduction of Treat and Referral among key Irish stakeholders; consultants in emergency medicine, paramedics and advanced paramedics.MethodsPublic-sector consultants in emergency medicine (EM), registered paramedics and advanced paramedics, in Ireland at the time of the study, were invited to complete an on-line survey.ResultsA significant finding was that 90% of both cohorts (EM consultants and registered paramedic practitioners) support written after-care instructions being given to referred patients, that > 83% agree that Treat and Referral will reduce unnecessary ambulance journeys and that 70% are in favour of their own family member being offered Treat and Referral. Consensus was reached between respondents that Treat and Referral would improve care and increase clinical judgement of practitioners. Differences were identified in relation to the increased availability of ambulances locally, that only adults should be included, and that research was required to extend Treat and Referral beyond the index conditions. There was no consensus on whether general practitioners (GPs) should be directly informed.ConclusionsThis study identified that the Irish healthcare practitioners surveyed are supportive of the introduction of Treat and Referral into Ireland. It also affords healthcare policymakers the opportunity to address the concerns raised, in particular the clinical level which will be targeted for inclusion in this extended scope of practice.

Highlights

The Irish ambulance services have traditionally transported all patients following an emergency (112/ 999) call, regardless of acuity, to an emergency department (ED)
Participant and setting The population consisted of consultants in emergency medicine in the public sector in Ireland, who were identified through the Irish Medical Directory [42], and paramedics and advanced paramedics on the Pre-Hospital Emergency Care Council (PHECC) register
Response rates Response rates differed between the clinical cohorts, n = 375 paramedics (27% of paramedics who received the survey), n = 244 advanced paramedics (80% of advanced paramedics who received the survey) and n = 39 (62% of consultants in emergency medicine who received the survey)

Summary

Introduction

The Irish ambulance services have traditionally transported all patients following an emergency (112/ 999) call, regardless of acuity, to an emergency department (ED). A proposal to introduce Treat and Referral, an established care pathway in some jurisdictions, is under active consideration in Ireland. The international literature has identified that a significant proportion of patients transported to an emergency department (ED) by ambulance do not have lifethreatening conditions [1 2] and do not necessarily require an ambulance to get to an ED. The literature suggests that between 30 and 50% of patients attending ED could be appropriately treated in less emergent settings [10,11,12,13]. One author has claimed that up to 80% of these inappropriate ED attenders could be treated adequately in a primary care setting [14].

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Conclusion