Abstract
BackgroundThere has been an increasing demand for emergency medical services (EMS), and a growing number of patients are not conveyed; i.e., they are referred to levels of care other than ambulance conveyance to the emergency department. Patient safety issues have been raised regarding the ability of EMS to decide not to convey patients. To improve non-conveyance guidelines, information is needed about patients who are not conveyed by EMS. Therefore, the purpose of this study was to describe and compare the proportion and characteristics of non-conveyed EMS patients, together with assignment data.MethodsA descriptive and comparative consecutive cohort design was undertaken. The decision of whether to convey patients was made by EMS according to a region-specific non-conveyance guideline. Non-conveyed patients’ medical record data were prospectively gathered from February 2016 to January 2017. Analyses was conducted using the chi-squared test, two-sample t test, proportion test and Mann-Whitneys U-test.ResultsOut of the 23,250 patients served during the study period, 2691 (12%) were not conveyed. For non-conveyed adults, the most commonly used Emergency Signs and Symptoms (ESS) codes were unspecific symptoms/malaise, abdomen/flank/groin pain, and breathing difficulties. For non-conveyed children, the most common ESS codes were breathing difficulties and fever of unclear origin. Most of the non-conveyed patients had normal vital signs. Half of all patients with a designated non-conveyance level of care were referred to self-care. There were statistically significant differences between men and women.ConclusionsFewer patients were non-conveyed in the studied region compared to national and international non-conveyance rates. The differences seen between men and women were not of clinical significance. Follow-up studies are needed to understand what effect patient outcome so that guidelines might improve.
Highlights
There has been an increasing demand for emergency medical services (EMS), and a growing number of patients are not conveyed; i.e., they are referred to levels of care other than ambulance conveyance to the emergency department
Taking ambulance availability into account when choosing not to convey patients from remote areas might jeopardize patient safety, since studies have shown that patients living further away from the hospital present themselves to EMS with more severe conditions than patients living in urban areas close to the hospital [16,17,18]
Patient characteristics and ambulance utilization In relation to the 23,250 patients served by the EMS, 2691 (12%) were not conveyed
Summary
There has been an increasing demand for emergency medical services (EMS), and a growing number of patients are not conveyed; i.e., they are referred to levels of care other than ambulance conveyance to the emergency department. The purpose of this study was to describe and compare the proportion and characteristics of nonconveyed EMS patients, together with assignment data. Both nationally and internationally, the demand for emergency medical services (EMS) has been growing approximately 3–5% annually [1, 2], and 40–79% of assessed patients do not need EMS interventions [3,4,5]. Taking ambulance availability into account when choosing not to convey patients from remote areas might jeopardize patient safety, since studies have shown that patients living further away from the hospital present themselves to EMS with more severe conditions than patients living in urban areas close to the hospital [16,17,18]
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