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© 2025 Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:  https://creativecommons.org/licenses/by/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Objectives

Ambulance clinicians use prealert calls to advise emergency departments (ED) of the arrival of patients requiring immediate review or intervention. Consistency of prealert practice is important in ensuring appropriate ED response to prealert calls. We used routine data to describe prealert practice and explore factors affecting variation in practice.

Design and setting

We undertook a retrospective observational study in three UK ambulance services using a linked dataset incorporating 12 months’ ambulance patient records, ambulance clinician data and emergency call data.

Outcome measures

We used least absolute shrinkage and selection operator regression to identify candidate variables for multivariate logistic regression models to predict variation in prealert use, analysing clinician factors (role, experience, qualification, time of prealert during shift), patient factors (National Early Warning Score version 2, clinical working impression, age, sex) and hospital factors (receiving ED, ED handover delay status).

Results

From the dataset of 1 363 274 patients conveyed to ED, 142 795 (10.5%) were prealerted, of whom 42 362 (30%) were for conditions with clear prealert pathways (eg, sepsis, stroke, ST-elevation myocardial infarction, major trauma). Prealert rates varied across and within different ambulance services. Casemix (illness acuity score, clinical diagnostic impression) was the strongest predictor of prealert use, but male patient sex, clinician role, receiving hospital and hospital turnaround delay at receiving hospitals were also statistically significant predictors, after adjusting for casemix. There was no evidence that prealert rates are higher during the final hour of shift.

Conclusions

Prealert decisions are influenced by factors other than illness acuity and clinical diagnostic impression alone. Variation in prealert practice suggests that procedures and processes for prealerting may lack clarity and improved prealert protocols may be required. Research is required to understand whether our findings are reproducible elsewhere and why non-clinical factors (eg, patient gender) may influence prealert practice.

Details

Title
What factors predict ambulance prealerts to the emergency department? Retrospective observational study from three UK ambulance services
Author
Pilbery, Richard 1   VIAFID ORCID Logo  ; Sampson, Fiona C 2   VIAFID ORCID Logo  ; Herbert, Esther 2 ; Goodacre, Steve 2   VIAFID ORCID Logo  ; Bell, Fiona 3   VIAFID ORCID Logo  ; Spaight, Rob 4 ; Rosser, Andy 5   VIAFID ORCID Logo  ; Webster, Peter 6 ; Millins, Mark 3 ; Pountney, Andrew 7 ; Coster, Joanne 2   VIAFID ORCID Logo  ; Long, Jaqui 2   VIAFID ORCID Logo  ; Rachel O’Hara 2   VIAFID ORCID Logo  ; Foster, Alexis 2   VIAFID ORCID Logo  ; Miles, Jamie 2   VIAFID ORCID Logo  ; Turner, Janette 2   VIAFID ORCID Logo  ; Boyd, Aimee 8   VIAFID ORCID Logo 

 Research and Development, Yorkshire Ambulance Service NHS Trust, Wakefield, UK 
 SCHARR, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK 
 Yorkshire Ambulance Service NHS Trust, Wakefield, UK 
 East Midlands Ambulance Service NHS Trust, Nottingham, UK 
 West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, UK 
 Leeds General Infirmary, Leeds, UK 
 Clinical Directorate, Yorkshire Ambulance Service NHS Trust, Wakefield, UK 
 South East Coast Ambulance Service NHS Foundation Trust, Banstead, UK 
First page
e097122
Section
Emergency medicine
Publication year
2025
Publication date
2025
Publisher
BMJ Publishing Group LTD
e-ISSN
20446055
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
3176359044
Copyright
© 2025 Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:  https://creativecommons.org/licenses/by/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.