Outcomes in patients not conveyed by emergency medical services (EMS): a one-year prospective study

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Abstract

Background

The decision to not convey patients has become common in emergency medical services worldwide. A substantial proportion (12–51%) of the patients seen by emergency medical services are not conveyed by those services. The practice of non-conveyance is a result of the increasing and changing demands on the acute care system. Research focusing on the outcomes of the decision by emergency medical services to not convey patients is needed.

Aim

The aim was to describe outcomes (emergency department visits, admission to in-hospital intensive care units and mortality, all within seven days) and their association with the variables (sex, age, day of week, time of day, emergency signs and symptoms codes, triage level colour, and destination) for non-conveyed patients.

Methods

This was a prospective analytical study with consecutive inclusion of all patients not conveyed by emergency medical services. Patients were included between February 2016 and January 2017. The study was conducted in Region Örebro county, Sweden. The region consists of both rural and urban areas and has a population of approximately 295,000. The region had three ambulance departments that received approximately 30,000 assignments per year.

Results

The result showed that no patient received intensive care, and 18 (0.7%) patients died within seven days after the non-conveyance decision. Older age was associated with a higher risk of hospitalisation and death within seven days after a non-conveyance decision.

Conclusions

Based on the results of this one-year follow-up study, few patients compared to previous studies were admitted to the hospital, received intensive care or died within seven days. This study contributes insights that can be used to improve non-conveyance guidelines and minimise the risk of patient harm.

Supplementary information

The online version contains supplementary material available at 10.1186/s13049-022-01023-3.

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Most cited references 32

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Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.

Erik von Elm, Douglas G. Altman, Matthias Egger … (2008)

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Older adults in the emergency department: a systematic review of patterns of use, adverse outcomes, and effectiveness of interventions.

Faranak Aminzadeh, William Burd Dalziel (2002)

We sought to synthesize the literature on patterns of use of emergency services among older adults, risk factors associated with adverse health outcomes, and effectiveness of intervention strategies targeting this population. Relevant articles were identified by means of an English-language search of MEDLINE, HealthSTAR, CINAHL, Current Contents, and Cochrane Library databases from January 1985 to January 2001. This search was supplemented with literature from reference sections of the retrieved publications. A qualitative approach was used to synthesize the literature. Compared with younger persons, older adults use emergency services at a higher rate, their visits have a greater level of urgency, they have longer stays in the emergency department, they are more likely to be admitted or to have repeat ED visits, and they experience higher rates of adverse health outcomes after discharge. The risk factors commonly associated with the negative outcomes are age, functional impairment, recent hospitalization or ED use, living alone, and lack of social support. Comprehensive geriatric screening and coordinated discharge planning initiatives designed to improve clinical outcomes in older emergency patients have provided inconclusive results. Older ED patients have distinct patterns of service use and care needs. The current disease-oriented and episodic models of emergency care do not adequately respond to the complex care needs of frail older patients. More research is needed to determine the effectiveness of screening and intervention strategies targeting at-risk older ED patients.

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Is Open Access

Towards an International Classification for Patient Safety: key concepts and terms

William B Runciman, Peter Hibbert, Richard G. Thomson … (2009)

Background Understanding the patient safety literature has been compromised by the inconsistent use of language. Objectives To identify key concepts of relevance to the International Patient Safety Classification (ICPS) proposed by the World Alliance For Patient Safety of the World Health Organization (WHO), and agree on definitions and preferred terms. Methods Six principles were agreed upon—that the concepts and terms should: be applicable across the full spectrum of healthcare; be consistent with concepts from other WHO Classifications; have meanings as close as possible to those in colloquial use; convey the appropriate meanings with respect to patient safety; be brief and clear, without unnecessary or redundant qualifiers; be fit-for-purpose for the ICPS. Results Definitions and preferred terms were agreed for 48 concepts of relevance to the ICPS; these were described and the relationships between them and the ICPS were outlined. Conclusions The consistent use of key concepts, definitions and preferred terms should pave the way for better understanding, for comparisons between facilities and jurisdictions, and for trends to be tracked over time. Changes and improvements, translation into other languages and alignment with other sets of patient safety definitions will be necessary. This work represents the start of an ongoing process of progressively improving a common international understanding of terms and concepts relevant to patient safety.

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Author and article information

Contributors

Erik Höglund:

ORCID: http://orcid.org/0000-0001-7885-694X

erik.hoglund@oru.se

Journal

Journal ID (nlm-ta): Scand J Trauma Resusc Emerg Med

Journal ID (iso-abbrev): Scand J Trauma Resusc Emerg Med

Title: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Publisher: BioMed Central (London )

ISSN (Electronic): 1757-7241

Publication date (Electronic): 13 June 2022

Publication date PMC-release: 13 June 2022

Publication date Collection: 2022

Volume: 30

Electronic Location Identifier: 40

Affiliations

[1 ]GRID grid.15895.30, ISNI 0000 0001 0738 8966, Faculty of Medicine and Health, University Health Care Research Centre, , Örebro University, ; Box 1613, 701 16 Örebro, Sweden

[2 ]GRID grid.5947.f, ISNI 0000 0001 1516 2393, Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, , NTNU-Norwegian University of Science and Technology, ; Gjøvik, Norway

[3 ]GRID grid.412442.5, ISNI 0000 0000 9477 7523, Faculty of Caring Science, Centre for Prehospital Research, Work Life and Social Welfare, , University of Borås, ; Borås, Sweden

[4 ]GRID grid.15895.30, ISNI 0000 0001 0738 8966, Department of Surgery, Faculty of Medicine and Health, , Örebro University, ; Örebro, Sweden

Author information

Erik Höglund http://orcid.org/0000-0001-7885-694X

Article

Publisher ID: 1023

DOI: 10.1186/s13049-022-01023-3

PMC ID: 9195370

PubMed ID: 35698086

SO-VID: cc64a480-58b5-408d-bd9b-7fb933658f5e

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 6 December 2021

Date accepted : 9 May 2022

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100009228, Region Örebro län;

Award ID: OLL-942072

Award ID: OLL-960656

Award ID: OLL-840471

Award Recipient : Erik Höglund

Custom metadata

ScienceOpen disciplines: Emergency medicine & Trauma

Keywords: ambulance,emergency medical services,non-conveyance,non-transport,outcome measures,triage,quality

Data availability:

ScienceOpen disciplines: Emergency medicine & Trauma

Keywords: ambulance, emergency medical services, non-conveyance, non-transport, outcome measures, triage, quality

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Outcomes in patients not conveyed by emergency medical services (EMS): a one-year prospective study

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Abstract

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Supplementary information

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Preventive and Emergency Medicine Insights

Most cited references 32

Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.

Older adults in the emergency department: a systematic review of patterns of use, adverse outcomes, and effectiveness of interventions.

Towards an International Classification for Patient Safety: key concepts and terms

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