Characteristics of non-conveyed patients in emergency medical services (EMS): a one-year prospective descriptive and comparative study in a region of Sweden

Abstract

Background There has been an increasing demand for emergency medical services (EMS), and a growing number of patients are not conveyed; i.e., they are referred to levels of care other than ambulance conveyance to the emergency department. Patient safety issues have been raised regarding the ability of EMS to decide not to convey patients. To improve non-conveyance guidelines, information is needed about patients who are not conveyed by EMS. Therefore, the purpose of this study was to describe and compare the proportion and characteristics of non-conveyed EMS patients, together with assignment data. Methods A descriptive and comparative consecutive cohort design was undertaken. The decision of whether to convey patients was made by EMS according to a region-specific non-conveyance guideline. Non-conveyed patients’ medical record data were prospectively gathered from February 2016 to January 2017. Analyses was conducted using the chi-squared test, two-sample t test, proportion test and Mann-Whitneys U-test. Results Out of the 23,250 patients served during the study period, 2691 (12%) were not conveyed. For non-conveyed adults, the most commonly used Emergency Signs and Symptoms (ESS) codes were unspecific symptoms/malaise, abdomen/flank/groin pain, and breathing difficulties. For non-conveyed children, the most common ESS codes were breathing difficulties and fever of unclear origin. Most of the non-conveyed patients had normal vital signs. Half of all patients with a designated non-conveyance level of care were referred to self-care. There were statistically significant differences between men and women. Conclusions Fewer patients were non-conveyed in the studied region compared to national and international non-conveyance rates. The differences seen between men and women were not of clinical significance. Follow-up studies are needed to understand what effect patient outcome so that guidelines might improve.

The Alternative Pre-hospital Pathway team: reducing conveyances to the emergency department through patient centered Community Emergency Medicine

“…Internationally non-conveyance rates vary greatly. Rates in the UK are 23-51%, [13] 20.4% in the Netherlands, [22] and between 10 and 22% in Sweden [12]. With a 68% non-conveyance rate, our data demonstrates that an APP Team is an effective model to reduce conveyances to hospital.…”

“…It is also a platform for integrating specialist hospital and community services, in certain cases aided by telemedicine, thereby enhancing the package of care delivery. This concept is similar to community paramedicine and mobile integrated care models used throughout North America [29] and guideline directed non-conveyance by specialist ambulance nurses in Europe [12].…”

“…Care is primarily paramedic led, with the exception of a few doctors around the country providing Pre-Hospital Emergency Medicine and critical care support on a voluntary basis. This is in contrast to EMS systems in continental Europe which rely heavily on physicians or specialist nurses for the provision of pre-hospital emergency care [11,12].…”

Advising and limiting medical treatment during phone consultation: a prospective multicentre study in HEMS settings

“…For example, across Scandinavia EMS personnel have the ability to consult with EMS physicians when they need advice [12][13][14][15], and according to a recent study HEMS physicians were consulted in 24% of all EMS missions in Finland [15]. Yet, little is known about the content of those consultation calls.…”

Non-conveyance of older adult patients and association with subsequent clinical and adverse events after initial assessment by ambulance clinicians: a cohort analysis

“…By its very nature, the ambulance service constitutes a high-risk patient safety environment which provides round-the-clock, year-round care services to a large volume of patients with a wide range of medical complaints [ 1 ]. Patients who are not transported to the hospital after an initial assessment by ambulance clinicians, that is, non-conveyed patients in the ambulance service [ 2 ], represent a significant and increasing proportion of those who seek ambulance services [ 3 – 6 ]. The research on patient outcome following non-conveyance is relatively sparse and, to some extent, has contrasting results [ 7 – 9 ].…”