Ambulance alerting to hospital: the need for clearer guidance

Background: The decision by paramedics to alert a receiving hospital to the imminent arrival of a critically ill patient is currently based on the crew's clinical judgement. Aims: To evaluate the efficiency of current alerting practice and to assess the need for objective guidelines. Methods: Data were collected in the Birmingham Heartlands Hospital, Birmingham, UK, over 1 week in February 2005. All alerted patients and all critically ill patients brought to the emergency department over this time period were identified. These two groups were studied to find those patients who were alerted but not critically ill, those who were critically ill but not alerted, and those who were both alerted and critically ill. The presenting conditions were identified and compared between groups. Results: 454 patients were brought by ambulance to the emergency department during the study week. Of the 27 alerted patients, 23 were critically ill, leaving four patients alerted inappropriately. 29 of the 52 critically ill patients had not been alerted by ambulance crews. Most (n = 22) of these patients were adults with medical conditions. Conclusions: Ambulance crews do not alert hospitals to critically ill patients adequately. The Modified Early Warning Score should be considered to be the basis of a prehospital tool to aid their decision.