Appropriateness of use of emergency ambulances.

Snooks, Helen; Wrigley, H; George, Steve; Thomas, Eileen; Smith, Helen; Glasper, Alan

doi:10.1136/emj.15.4.212

Cited by 70 publications

(45 citation statements)

References 15 publications

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“…[7][8][9][10][11][12] In 2001, the National Association of EMS Physicians (NAEMSP) recognized that nontransport decisions may be initiated by patients or by EMS personnel, 13 and that "transportation by alternate means or to an alternate destination may be appropriate" for nonurgent patients. 14 Systems that establish nontransport and alternate-destination protocols, however, must ensure physician oversight of the program, adequate education of the EMS providers, and a strong quality management system.…”

Section: Introductionmentioning

confidence: 99%

EMS Provider Determinations of Necessity for Transport and Reimbursement for EMS Response, Medical Care, and Transport: Combined Resource Document for the National Association of EMS Physicians Position Statements

Millin

Brown²,

Schwartz

2011

Prehospital Emergency Care

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With increasing demands for emergency medical services (EMS), many EMS jurisdictions are utilizing EMS providerinitiated nontransport policies as a method to offload potentially nonemergent patients from the EMS system. EMS provider determination of medical necessity, resulting in nontransport of patients, has the potential to avert unnecessary emergency department visits. However, EMS systems that utilize these policies must have additional education for the providers, a quality improvement process, and active physician oversight. In addition, EMS provider determination of nontransport for a specific situation should be supported by evidence in the peer-reviewed literature that the practice is safe. Further, EMS systems that do not utilize these programs should not be financially penalized. Payment for EMS services should be based on the prudent layperson standard. EMS systems that do utilize nontransport policies should be appropriately reimbursed, as this represents potential cost savings to the health care system.

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Section: Introductionmentioning

confidence: 99%

EMS Provider Determinations of Necessity for Transport and Reimbursement for EMS Response, Medical Care, and Transport: Combined Resource Document for the National Association of EMS Physicians Position Statements

Millin

Brown²,

Schwartz

2011

Prehospital Emergency Care

View full text Add to dashboard Cite

show abstract

“…Up to 40-50% of patient requests for emergency transport have been described as potentially avoidable or unnecessary, [44][45][46][47][48][49][50] being more suited to alternative community services, such as social, psychiatric or district nursing services 44 ; or warranting transport to the ED by alternative means such as a non-emergency vehicle. 49 However, it is difficult to define what is inappropriate or unnecessary, as clinicians and patients may hold different viewpoints.…”

Section: Appropriate Use and Accessibility To Alternative Servicesmentioning

confidence: 99%

Increasing utilisation of emergency ambulances

Lowthian¹,

Cameron²,

Stoelwinder³

et al. 2011

Aust. Health Review

172

161

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Background. Increased ambulance utilisation is closely linked with Emergency Department (ED) attendances. Pressures on hospital systems are widely acknowledged with ED overcrowding reported regularly in the media and peer-reviewed literature. Strains on ambulance services are less well-documented or studied.Aims. To review the literature to determine the trends in utilisation of emergency ambulances throughout the developed world and to discuss the major underlying drivers perceived as contributing to this increase.Method. A search of online databases, search engines, peer-reviewed journals and audit reports was undertaken. Findings. Ambulance utilisation has increased in many developed countries over the past 20 years. Annual growth rates throughout Australia and the United Kingdom are similar. Population ageing, changes in social support, accessibility and pricing, and increasing community health awareness have been proposed as associated factors. As the extent of their contribution has not yet been established these factors were reviewed.Conclusion. The continued rise in utilisation of emergency ambulances is placing increasing demands on ambulance services and the wider health system, potentially compromising access, quality, safety and outcomes. A variety of factors may contribute to this increase and targeted strategies to reduce utilisation will require an accurate identification of the major drivers of demand.What is known about the topic? Ambulance utilisation is increasing annually throughout the developed world, with previous research suggesting numerous underlying factors. What does this paper add? These factors have not been previously synthesised in the international literature. This narrative review clearly articulates the underlying problems. What are the implications for practitioners? This paper outlines the need for further research of the causes of increased emergency ambulance utilisation, to enable the development of appropriate strategies to manage demand in the future.

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“…This figure is similar to that in one of the studies conducted in SA, [6] with international studies reporting rates of between 11% and 52%. [5] There is undoubtedly an urgent need for the eThekwini EMS to review its existing strategies relating to decisions made on the allocation of resources based upon patient need. Adopting evidence-based alternatives to the traditional dispatch of emergency ambulances and the transportation of patients to primary admitting centres may be a way to achieve this.…”

Section: Discussionmentioning

confidence: 99%

“…[5] Three studies have been undertaken in South Africa (SA). Frank and De Villiers [6] showed that up to 68% of the cases transported by the Caledon EMS in Overberg, Western Cape Province, were not emergencies and that the inappropriate use of EMS units resulted in unnecessary costs.…”

mentioning

confidence: 99%

The appropriateness of emergency medical service responses in the eThekwini district of KwaZulu-Natal, South Africa

Newton

Brysiewicz

2015

S Afr Med J

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Introduction. Emergency medical services (EMS) are sometimes required to respond to cases that are later found not to be emergencies, resulting in high levels of inappropriate responses. This study evaluated the extent to which this occurs. Methods. All cases dispatched over 72 hours by the eThekwini EMS in Durban, South Africa, were prospectively enrolled in a quantitative descriptive study. Vehicle control forms containing dispatch data were matched and compared with patient report forms containing epidemiological and clinical data to describe the nature and extent of inappropriate responses based on patient need. Data were subjected to simple descriptive analysis, correlations and χ 2 testing. Results. A total of 1 385 cases met the study inclusion criteria. Marked variations existed between dispatch and on-scene priority settings, most notably in the highest priority 'red-code' category, which constituted >56% of cases dispatched yet accounted for <2% at the scene (p<0.001). Conversely, >80% of 'red-code' dispatches required a lower priority response. When comparing resource allocation according to patient interventional needs, >58% of cases required either no intervention or transport only and almost 36% required basic life support intervention only (p<0.001). Moreover, <12% of advanced life support dispatches were for patients found to be 'red code' at the scene. Conclusion. There is a significant mismatch between the dispatch of EMS resources and actual patient need in the eThekwini district, with significantly high levels of inappropriate emergency responses.

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Appropriateness of use of emergency ambulances.

Cited by 70 publications

References 15 publications

EMS Provider Determinations of Necessity for Transport and Reimbursement for EMS Response, Medical Care, and Transport: Combined Resource Document for the National Association of EMS Physicians Position Statements

EMS Provider Determinations of Necessity for Transport and Reimbursement for EMS Response, Medical Care, and Transport: Combined Resource Document for the National Association of EMS Physicians Position Statements

Increasing utilisation of emergency ambulances

The appropriateness of emergency medical service responses in the eThekwini district of KwaZulu-Natal, South Africa

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