Rationale, aims and objectives: The objective of this study was to develop a questionnaire measuring the level of trust and its constituents in patients calling the Emergency Medical Services (EMS) for suspected acute primary healthcare problems. The questionnaire is called the Patient Trust Questionnaire (PTQ). The following frontline service providers were involved: (1) The Dispatch Centre, (2) the Emergency Medical Services, and (3) the receiving unit (Emergency Department/Healthcare Centre). Method: Cross-sectional data were collected repeatedly and redundant items were discarded using a step-by-step approach. Based on a literature review, the PTQ was developed in line with the following 4-step procedure: (1) Item construction, (2) a face-to-face evaluation of separate items, (3) an empirical pre-evaluation targeting each separate frontline service provider and (4) an empirical full-scale evaluation. The inclusion criteria for participating were that the patient must be 18 years of age or older and suspected having an acute primary healthcare problem when calling the EMS. In the final full-scale evaluation of the questionnaire, 427 patients were included. Results: A set of 8 items with good psychometric properties remained through the developing procedure. Two constituents of trust emerged (labelled credibility and accessibility), which were robust across all frontline service providers. Conclusion: A new measuring instrument has been developed for this particular healthcare chain, for patients with suspected acute primary healthcare problems calling the EMS.Although not yet validated, the PTQ is a potentially useful tool in future healthcare research with reference to the concept of patient trust.
Background The emergency medical services (EMS) have undergone dramatic changes during the past few decades. Increased utilisation, changes in care-seeking behaviour and competence among EMS clinicians have given rise to a shift in EMS strategies in many countries. From transport to the emergency department to at the scene deciding on the most appropriate level of care and mode of transport. Among the non-conveyed patients some may suffer from “time-sensitive conditions” delaying diagnosis and treatment. Thus, four questions arise: How often are time-sensitive cases referred to primary care or self-care advice? How can we measure and define the level of inappropriate clinical decision-making? What is acceptable? How to increase patient safety? Main text To what extent time-sensitive cases are non-conveyed varies. About 5–25% of referred patients visit the emergency department within 72 hours, 5% are hospitalised, 1–3% are reported to have a time-sensitive condition and seven-day mortality rates range from 0.3 to 6%. The level of inappropriate clinical decision-making can be measured using surrogate measures such as emergency department attendances, hospitalisation and short-term mortality. These measures do not reveal time-sensitive conditions. Defining a scoring system may be one alternative, where misclassifications of time-sensitive cases are rated based on how severely they affected patient outcome. In terms of what is acceptable there is no general agreement. Although a zero-vision approach does not seem to be realistic unless under-triage is split into different levels of severity with zero-vision in the most severe categories. There are several ways to reduce the risk of misclassifications. Implementation of support systems for decision-making using machine learning to improve the initial assessment is one approach. Using a trigger tool to identify adverse events is another. Conclusion A substantial number of patients are non-conveyed, including a small portion with time-sensitive conditions. This poses a threat to patient safety. No general agreement on how to define and measure the extent of such EMS referrals and no agreement of what is acceptable exists, but we conclude an overall zero-vision is not realistic. Developing specific tools supporting decision making regarding EMS referral may be one way to reduce misclassification rates.
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