Abstract
BackgroundSome patients calling ambulance services (known as Emergency Medical Services internationally) are not transported to hospital. In England, national ambulance quality indicators show considerable variation in non-transport rates between the ten large regional ambulance services. The aim of this study was to explain variation between ambulance services in two types of non-transport: discharge at scene and telephone advice.MethodsMixed model logistic regressions using one month of data (November 2014) from the Computer Aided Despatch systems of the ten large regional ambulance services in England.Results41% (251 677/615 815) of patients calling ambulance services were not transported to hospital. Most were discharged at scene after attendance by an ambulance (29% n = 182 479) and a small percentage were given telephone advice (7% n = 40 679). Discharge at scene rates varied by patient-level factors e.g. they were higher for elderly patients, where the reason for calling was falls, and for patients attended by paramedics with extended skills. These patient-level factors did not explain variation between ambulance services. After adjustment for patient-level factors, the following ambulance service level factors explained variation in discharge at scene rates: proportion of patients attended by paramedics with extended skills (odds ratio 1.05 (95% CI 1.04, 1.07)), the perception of ambulance service staff that paramedics with extended skills were established and valued within the workforce (odds ratio 1.84 (1.45, 2.33), and the perception of ambulance service staff that senior management viewed non-transport as risky (odds ratio 0.78 (0.63, 0.98)). Variation in telephone advice rates could not be explained.ConclusionsVariation in discharge at scene rates was explained by differences in workforce configuration and managerial motivation, factors that are largely modifiable by ambulance services.
Highlights
Not all patients calling ambulance services, or Emergency Medical Services as they are known as in some countries, are transported to a hospital
Variation in discharge at scene rates was explained by differences in workforce configuration and managerial motivation, factors that are largely modifiable by ambulance services
The dataset of 615 815 calls was larger than the one reported in national ambulance quality indicators for non-transport (538,865) in November 2014 because it included calls from National Health Service (NHS) 111 which are excluded from the denominator of the national ambulance quality indicators. 41% (251 677/615 815) of patients calling ambulance services were not transported to hospital
Summary
Not all patients calling ambulance services, or Emergency Medical Services as they are known as in some countries, are transported to a hospital. In the United Kingdom (UK) there are currently three main types in use: telephone advice to self-manage or contact another service, given by clinicians based in the ambulance service; discharge at scene after a face-to-face contact with an ambulance crew where the crew offer treatment and advice to patients; or transport by ambulance to a service other than a hospital with an emergency department, such as a walk-in or urgent care centre. These types of non-transport to a hospital are in use internationally. The aim of this study was to explain variation between ambulance services in two types of non-transport: discharge at scene and telephone advice
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