Contacting out-of-hours primary care or emergency medical services for time-critical conditions - impact on patient outcomes

Søvsø, Morten Breinholt; Christensen, Morten Bondo; Bech, Bodil Hammer; Christensen, Helle Collatz; Christensen, Erika Frischknecht; Huibers, Linda

doi:10.1186/s12913-019-4674-0

Cited by 23 publications

(30 citation statements)

References 38 publications

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“…We defined a time-sensitive diagnosis as a diagnosis when urgent care and treatment are vital to limit organ damage and to avoid severe complications and early death (e.g. pulmonary oedema, acute myocardial infarction and sepsis) [ 3 , 11 ]. This definition has been previously described [ 3 ], but some additional diagnoses (e.g.…”

Section: Methodsmentioning

confidence: 99%

Pre-hospital predictors of an adverse outcome among patients with dyspnoea as the main symptom assessed by pre-hospital emergency nurses - a retrospective observational study

et al. 2020

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Background Dyspnoea is one of the most common reasons for patients contacting emergency medical services (EMS). Pre-hospital Emergency Nurses (PENs) are independently responsible for advanced care and to meet these patients individual needs. Patients with dyspnoea constitute a complex group, with multiple different final diagnoses and with a high risk of death. This study aimed to describe on-scene factors associated with an increased risk of a time-sensitive final diagnosis and the risk of death. Methods A retrospective observational study including patients aged ≥16 years, presenting mainly with dyspnoea was conducted. Patients were identified thorough an EMS database, and were assessed by PENs in the south-western part of Sweden during January to December 2017. Of 7260 missions (9% of all primary missions), 6354 were included. Among those, 4587 patients were randomly selected in conjunction with adjusting for unique patients with single occasions. Data were manually collected through both EMS- and hospital records and final diagnoses were determined through the final diagnoses verified in hospital records. Analysis was performed using multiple logistic regression and multiple imputations. Results Among all unique patients with dyspnoea as the main symptom, 13% had a time-sensitive final diagnosis. The three most frequent final time-sensitive diagnoses were cardiac diseases (4.1% of all diagnoses), infectious/inflammatory diseases (2.6%), and vascular diseases (2.4%). A history of hypertension, renal disease, symptoms of pain, abnormal respiratory rate, impaired consciousness, a pathologic ECG and a short delay until call for EMS were associated with an increased risk of a time-sensitive final diagnosis. Among patients with time-sensitive diagnoses, approximately 27% died within 30 days. Increasing age, a history of renal disease, cancer, low systolic blood pressures, impaired consciousness and abnormal body temperature were associated with an increased risk of death. Conclusions Among patients with dyspnoea as the main symptom, age, previous medical history, deviating vital signs, ECG pattern, symptoms of pain, and a short delay until call for EMS are important factors to consider in the prehospital assessment of the combined risk of either having a time-sensitive diagnosis or death.

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Section: Methodsmentioning

confidence: 99%

Pre-hospital predictors of an adverse outcome among patients with dyspnoea as the main symptom assessed by pre-hospital emergency nurses - a retrospective observational study

et al. 2020

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“…[4][5][6][7][8] However, possible overlaps in the EMS and OOH-PC patient populations have been observed; some patients in need of acute care contact OOH-PC and some patients with non-specific complaints perhaps more suitable for OOH-PC contact EMS. [9][10][11][12] Besides the patient's self-perceived urgency and severity of the acute health problem, other factors play a role in the choice of entrance to out-of-hours (OOH) care. A number of studies have found that sociodemographic characteristics such as low education, ethnicity and older age and factors regarding the health-care system itself (organization of access to primary care) were associated with help-seeking, but no large-scale cohort studies have investigated differences in these characteristics for patients contacting EMS and OOH-PC.…”

Section: Introductionmentioning

confidence: 99%

<p>Sociodemographic Characteristics Associated with Contacts to Emergency Medical Services and Out-of-Hours Primary Care: An Observational Study of 2.3 Million Citizens</p>

Søvsø¹,

Bech²,

Christensen³

et al. 2020

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Background: Out-of-hours (OOH) health care services are often divided into emergency medical services (EMS) and OOH primary care (OOH-PC). EMS and many OOH-PC use telephone triage, yet the patient still makes the initial choice of contacting a service and which service. Sociodemographic characteristics are associated with help-seeking. Yet, differences in characteristics for EMS and OOH-PC patients have not been investigated in any large-scale cohort studies. Such knowledge may contribute to organizing OOH services to match patient needs. Thus, in this study we aimed to explore which sociodemographic patient characteristics were associated with utilizing OOH health care and to explore which sociodemographic characteristics were associated with EMS or OOH-PC contact. Methods: A population-based observational cohort study of inhabitants in two regions (North Denmark Region and Capital Region of Copenhagen) with or without contact to OOH services during 2016 was conducted. Associations between sociodemographic characteristics and OOH contacts (and EMS versus OOH-PC contact) were evaluated by regression analyses. Results: We identified 619,857 patients with OOH contact. Female sex (IRR=1.16 (95% CI: 1.16-1.17)), non-western ethnicity (IRR=1.02 (95% CI: 1.01-1.02)), living alone (IRR=1.08 (95% CI: 1.08-1.09)), age groups ≥81 years (IRR=2.00 (95% CI: 1.98-2.02)) and 0-18 years (IRR=1.66 (95% CI: 1.66-1.67)) and low income (IRR=1.41 (95% CI: 1.40-1.42)) were more likely to contact OOH health care compared to males, Danish ethnicity, citizens cohabitating, age 31-65 years and high income. Disability pensioners more often contacted OOH care (IRR=1.79 (95% CI: 1.77-1.81) compared to employees. Old age (≥81 years) (OR=3.21 (95% CI: 3.13-3.30)), receiving cash benefits (OR=2.45 (95% CI: 2.36-2.54)), low income (OR=1.76 (95% CI: 1.72-1.81)) and living alone (OR=1.40 (95% CI: 1.37-1.42)) were all associated with EMS contacts rather than OOH-PC contacts. Conclusion: Several sociodemographic factors were associated with contacting a health care service outside office hours and with contacting EMS rather than OOH-PC. Old age, low income, low education and low socioeconomic status were of greatest importance.

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“…Sometimes patients have attended with acute conditions that the PCEC is unable to manage causing delay in transfer of patients to the appropriate level of care. The risk of harm when a patient's needs are greater than those that can be provided for is a recognised issue for urgent care services worldwide (Søvsø et al, 2019). Since the onset of the Coronavirus epidemic the number of 'walk-in' patients presenting has greatly reduced, but they do still present.…”

Section: 'Walk-in' Patientsmentioning

confidence: 99%

An introduction to urgent care for the GP trainee

Hodgins

McEntee

2021

InnovAiT

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Working in urgent care requires the ability to manage medical, surgical, social and mental health presentations. It is essential to understand the organisational aspects of how such care is provided. Communication and consultation skills need to be adapted to different clinical contexts. Self-management of safety, time, and stress are important capabilities. One of the requirements of GP training is to demonstrate capabilities in urgent care, including delivery of safe patient care, demonstration of effective communication skills, maintaining continuity for patients and coordinating care across services. In this article we aim to give GP trainees an overview of the urgent care service in Scotland and to give advice on best practice.

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Contacting out-of-hours primary care or emergency medical services for time-critical conditions - impact on patient outcomes

Cited by 23 publications

References 38 publications

Pre-hospital predictors of an adverse outcome among patients with dyspnoea as the main symptom assessed by pre-hospital emergency nurses - a retrospective observational study

Pre-hospital predictors of an adverse outcome among patients with dyspnoea as the main symptom assessed by pre-hospital emergency nurses - a retrospective observational study

<p>Sociodemographic Characteristics Associated with Contacts to Emergency Medical Services and Out-of-Hours Primary Care: An Observational Study of 2.3 Million Citizens</p>

An introduction to urgent care for the GP trainee

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