Epidemiological Determinants of Patient Non-Conveyance to the Hospital in an Emergency Medical Service Environment

Abstract

Background: The increasing prevalence of comorbidities worldwide has spurred the need for time-effective pre-hospital emergency medical services (EMS). Some pre-hospital emergency calls requesting EMS result in patient non-conveyance. Decisions for non-conveyance are sometimes driven by the patient or the clinician, which may jeopardize the patients’ healthcare outcomes. This study aimed to explore the distribution and determinants of patient non-conveyance to hospitals in a Middle Eastern national Ambulance Service that promotes the transportation of all emergency call patients and does not adopt clinician-based non-conveyance decision. Methods: Using R Language, descriptive, bivariate, and binary logistic regression analyses were conducted for 334,392 multi-national patient non-conveyance emergency calls from June 2018 to July 2022, from a total of 1,030,228 calls to which a response unit was dispatched. Results: After data pre-processing, 237,862 cases of patient non-conveyance to hospital were retained, with a monthly average of 41.96% (n = 8799) of the emergency service demands and a standard deviation of 5.49% (n = 2040.63). They predominantly involved South Asians (29.36%, n = 69,849); 64.50% (n = 153,427) were of the age category from 14 to 44 years; 61.22% (n = 145,610) were male; 74.59% (n = 177,424) from the urban setting; and 71.28% (n = 169,552) had received on-scene treatment. Binary logistic regression with full variables and backward methods identified the final models of the determinants of patient non-conveyance decisions with an Akaike information criterion prediction estimator, respectively, of (250,200) and (250,169), indicating no significant difference between both models (Chi-square test; p-value = 0.63). Conclusions: Despite exercising a cautious protocol by encouraging patient transportation to hospital, patient non-conveyance seems to be a problem in the healthcare system that strains the pre-hospital medical response teams’ resources. Policies and regulations should be adopted to encourage individuals to access other primary care centers when required rather than draining emergency services for non-emergency situations.

Provision of bystander CPR for out-of-hospital cardiac arrest in the Middle East: a retrospective gender-based analysis

“…While the primary focus of this study is the provision of bystander CPR, it is important to acknowledge that the EMS system in Qatar, which includes treatment protocol and advanced interventions, could influence achievement of ROSC and overall survival rate [ 27 , 36 ]. Nevertheless, our finding showed bystander CPR rate remains relatively low.…”

Predictive modelling of transport decisions and resources optimisation in pre-hospital setting using machine learning techniques

“…Such targeted predictive analysis can substantially ease financial and logistical pressures on pre-hospital care systems, for instance, by fine-tuning dispatch protocols to recognise better patients with low-acuity complaints who may request not to be transported. In such instances, alternative resources like "non-transport units" equipped with less costly medical equipment could be allocated rather than dispatching emergency response units, which are over-equipped and crewed by highly qualified staff like critical care paramedics as they are designed for more critical patients [28,29]. This approach may not only lead to fuel, workforce, and vehicle maintenance savings.…”

Factors influencing non-conveyance care encounters in the ambulance service, registered nurses experiences - a qualitative study

“…Most of the non-conveyed patients are dispatched with the highest priority [ 15 ], reasons are not fully clear but may indicate the complexity of assessing emergency calls [ 18 ] or not asking the right questions to the caller [ 19 ]. Regardless, there is an increased demand for ambulance services that are not related to acute illness or injury [ 6 , 7 , 20 , 21 ]. This can be attributed to several factors, the care seekers have a lower threshold for calling the emergency number [ 10 ], an aging population has increased emergency care needs [ 22 ], the accessibility to ambulance service has improved while health literacy has decreased among the care-seekers [ 7 ] and in addition, the ambulance services can provide assessment and care that includes alternative care pathways excluding the emergency department as a final destination [ 23 ].…”