A novel approach for managing the growing demand for ambulance services by low-acuity patients

Abstract

Objective. The aim of the present study was to describe the Ambulance Victoria (AV) secondary telephone triage service, called the Referral Service (RS), for low-priority patients calling triple zero. This service provides alternatives to ambulance dispatch, such as doctor or nurse home visits.Methods. A descriptive epidemiological review of all the cases managed between 2009 and 2012 was conducted, using data from AV case records, the Victorian Admitted Episodes Dataset and the Australian Bureau of Statistics. Cases were reviewed for patient demographics, condition, final disposition and RS outcome.Results. In all, 107 148 cases were included in the study, accounting for 10.3% of the total calls for ambulance attendance. Median patient age was 54 years and 55% were female. Geographically based socioeconomic status was associated with the rate of calls to the RS (r = -0.72; 95% confidence interval CI -0.104, -0.049; P < 0.001). Abdominal pain and back symptoms were the most common patient problems. Although 68% of patients were referred to the emergency department, only 27.6% of the total cases were by emergency ambulance; the remainder were diverted to non-emergency ambulance or the patient's own private transport. The remaining 32% of cases were referred to alternative service providers or given home care advice.Conclusions. This paper describes the use of an ongoing secondary triage service, providing an effective strategy for managing emergency ambulance demand.What is known about the topic? Some calls to emergency services telephone numbers for ambulance assistance consist of cases deemed to be low-acuity that could potentially be better managed in the primary care setting. The demand on ambulance resources is increasing each year. Secondary telephone triage systems have been trialled in ambulance services in the US and UK with minimal success in terms of overall impact on ambulance resourcing. What does this paper add? This study describes a model of secondary telephone triage in the ambulance setting that has provided an effective way to divert patients to more suitable forms of health care to meet their needs. What are the implications for practitioners? The implications for practitioners are vast. Some of the issues that currently face paramedics include: fatigue because of high workloads; skills decay because of a lack of exposure to patients requiring intervention with skills the paramedics have, as well as a lack of time for paramedics to practice these skills during their downtime; and decreasing job satisfaction linked to both these factors. Implications for patients include quicker response times because more ambulances will be available to respond and increased patient safety because of decreased fatigue and higher skill levels in paramedics.

High‐resolution mapping of epilepsy prevalence, ambulance use, and socioeconomic deprivation in an urban area of Sweden

“…The proportion of patients transported to hospital did not differ between geographic areas of different socioeconomic standing, which could suggest that patients in the poorer areas did not have a good alternative to calling EMS. A higher frequency of ambulance calls in socioeconomic weaker areas and an association with low‐acuity calls has been reported from other countries, and patients from lower socioeconomic areas are twice as likely to seek urgent emergency department care, suggesting that this is not a local factor . A second, but not mutually exclusive, explanation could be that EMS calls are placed later in relation to symptom onset in poorer areas, and that patients have recovered when paramedics arrive.…”

Epidemiology of trauma patients attended by ambulance paramedics in Perth, Western Australia

“…Only a small percentage of patients in our study were high acuity, the majority being low acuity. This is demonstrated by the small percentage of advanced life support interventions undertaken . A comparable distribution was reported in NSW where hospital triage level was used to define acuity level .…”

“…The lack of paramedic exposure to high‐acuity patients and the resulting skill decay and decreasing job satisfaction has previously been reported . More concerning is the impact the increase in low‐acuity patients has on response times to high‐acuity patients . However, although low‐acuity patients may not require immediate advanced life support it is important that they are included when considering the total burden of injury.…”

Emergency demand, repeat and frequent presentations by older patients in metropolitan Melbourne: A retrospective cohort study using routinely collected hospital data

“…Importantly, the number of patients attending for PAGP‐type presentations decreased during the 5‐year study period, accounting for just 12.8% of all visits by older people in 2012. This suggests that initiatives to divert such visits away from ED have had some effect, such as Ambulance Victoria’s Referral Service, established in 2003, that facilitates direct referral to a community‐based service or telephone advice service as an alternative to being transported to the ED . Although there is a paucity of evidence for most other diversion strategies, it is also possible that chronic disease management programmes, establishment of Super Clinics that encompass allied health, imaging and pathology services with increased availability of after‐hours care by GPs, co‐location of GP clinics in acute hospitals, and the work of Primary Health Networks (formerly Medicare Locals) may have reduced PAGP‐type ED re‐presentations.…”