EMS non-conveyance: A safe practice to decrease ED crowding or a threat to patient safety?

Jani Paulin,Mari Koivisto,Timo Iirola,Jouni Kurola

doi:10.1186/s12873-021-00508-1

Abstract

BackgroundThe safety of the Emergency Medical Service’s (EMS’s) non-conveyance decision was evaluated by EMS re-contacts, primary health care or emergency department (ED) visits, and hospitalization within 48 h. The secondary outcome was 28-day mortality.MethodsThis cohort study used prospectively collected data on non-conveyed EMS patients from three different regions in Finland between June 1 and November 30, 2018. The Adjusted International Classification of Primary Care (ICPC2) as the reason for care was compared to hospital discharge diagnoses (ICD10). Multivariable logistic regressions were used to determine factors that were independently associated with adverse outcomes. Results are presented with adjusted odds ratios (aORs) together with 95% confidence intervals (CIs). Data regarding deceased patients were reviewed by the study group.ResultsOf the non-conveyed EMS patients (n = 11,861), 6.3% re-contacted the EMS, 8.3% attended a primary health care facility, 4.2% went to the ED, 1.6% were hospitalized, and 0.1% died 0–24 h after the EMS mission. The 0–24 h adverse event rate was higher than 24–48 h. After non-conveyance, 32 (0.3%) patients were admitted to an intensive care unit within 24 h. Primary non-urgent EMS mission (aOR 1.49; 95% CI 1.25 to 1.77), EMS arrival at night (aOR 1.82; 95% CI 1.58 to 2.09), ALS unit type vs BLS (aOR 1.43; 95% CI 1.16 to 1.77), rural area (aOR 1.74; 95% CI 1.51 to 1.99), and older patient age (aOR 1.41; 95% CI 1.20 to 1.66) were associated with subsequent primary health care visits (0–24 h).ConclusionsFour in five non-conveyed patients did not have any re-contact in follow-up period. EMS non-conveyance seems to be a relatively safe method of focusing ED resources and avoiding ED crowding.

Highlights

The safety of the Emergency Medical Service’s (EMS’s) non-conveyance decision was evaluated by Emergency medical services (EMS) re-contacts, primary health care or emergency department (ED) visits, and hospitalization within 48 h
EMS care providers’ higher education level [3, 8], EMS arrival time in the evening or at night [3, 7, 9, 10], longer distance to Paulin et al BMC Emergency Medicine (2021) 21:115 a healthcare facility [7], rural area, younger patient age [3, 10, 11], low National Early Warning Score (NEWS2), and alcohol use increase the likelihood of nonconveyance [3]
The aim of this study was to identify the rate and predictors of adverse outcomes after non-conveyance by the EMSs to determine whether the current practice of nonconveyance ensures patient safety

Summary

Introduction

The safety of the Emergency Medical Service’s (EMS’s) non-conveyance decision was evaluated by EMS re-contacts, primary health care or emergency department (ED) visits, and hospitalization within 48 h. Emergency Medical Services (EMSs) and emergency departments (EDs) have reported increased workload [1, 2], mainly due to an aging population and difficulties accessing primary care [2]. The role of the EMS has changed to include more non-critical emergency patients [3], and patients are increasingly assessed and treated at the scene by EMSs, avoiding unnecessary conveyance to EDs [4]. A recent review showed that, after a non-conveyance decision, re-contact with the EMS or the ED, hospitalization and mortality rates varied a lot [5]. Whether re-contact with EMS was for a similar reason as the initial EMS contact is unclear [5]

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