Frequent Users of 9-1-1 Emergency Medical Services: Sign of Success or Symptom of Impending Failure?

Raven, Maria C.; Tangherlini, Niels; Hall, M. Kennedy

doi:10.1080/10903127.2018.1475531

Cited by 6 publications

(7 citation statements)

References 19 publications

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“…Moreover, patients served by EMS tend to require substantial health care resources, as indicated by their need for mobile nursing services and transport. However, the potential of using EMS data to identify frequent users and their consumption patterns has hardly been acknowledged in the literature [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Identifying Frequent Health Care Users and Care Consumption Patterns: Process Mining of Emergency Medical Services Data

2021

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Background Tracing frequent users of health care services is highly relevant to policymakers and clinicians, enabling them to avoid wasting scarce resources. Data collection on frequent users from all possible health care providers may be cumbersome due to patient privacy, competition, incompatible information systems, and the efforts involved. Objective This study explored the use of a single key source, emergency medical services (EMS) records, to trace and reveal frequent users’ health care consumption patterns. Methods A retrospective study was performed analyzing EMS calls from the province of Drenthe in the Netherlands between 2012 and 2017. Process mining was applied to identify the structure of patient routings (ie, their consecutive visits to hospitals, nursing homes, and EMS). Routings are used to identify and quantify frequent users, recognizing frail elderly users as a focal group. The structure of these routes was analyzed at the patient and group levels, aiming to gain insight into regional coordination issues and workload distributions among health care providers. Results Frail elderly users aged 70 years or more represented over 50% of frequent users, making 4 or more calls per year. Over the period of observation, their annual number and the number of calls increased from 395 to 628 and 2607 to 3615, respectively. Structural analysis based on process mining revealed two categories of frail elderly users: low-complexity patients who need dialysis, radiation therapy, or hyperbaric medicine, involving a few health care providers, and high-complexity patients for whom routings appear chaotic. Conclusions This efficient approach exploits the role of EMS as the unique regional “ferryman,” while the combined use of EMS data and process mining allows for the effective and efficient tracing of frequent users’ utilization of health care services. The approach informs regional policymakers and clinicians by quantifying and detailing frequent user consumption patterns to support subsequent policy adaptations.

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Section: Introductionmentioning

confidence: 99%

Identifying Frequent Health Care Users and Care Consumption Patterns: Process Mining of Emergency Medical Services Data

2021

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“…[1] UK ambulance services have addressed this for adult populations by standardising the definition. [8] There has been a call for more standard definitions of frequent use without specifying whether this should be paediatric or adult populations, [35] but there is as of yet no common definition of paediatric frequent use. Without further research to better understand paediatric frequent use it is not possible to speculate on what a definition may look like.…”

Section: Discussionmentioning

confidence: 99%

Paediatric frequent use of emergency medical services: a systematic review

et al. 2022

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BackgroundFrequent use of emergency medical services (EMS) is recognised to be a global phenomenon, although paediatric frequent use is poorly understood. This systematic review aimed to understand how paediatric frequent use of EMS is currently defined, identify factors associated with paediatric frequent use of EMS and determine effectiveness of interventions for paediatric patients who frequently use EMS.MethodsFour electronic databases (Medline, CINAHL, Web of Science and PsycINFO) were searched to September 2022 for primary, peer-reviewed research studies published in English from January 2000. Studies were included that examined frequent use (>1 contact during study period) of EMS or other services with arrival via EMS. Paediatric patients were defined as <18 years of age or otherwise defined by study authors as paediatric/adolescent/children. Data were extracted using a structured proforma, and quality was assessed using the Standard Quality Assessment Criteria for Quantitative Studies but did not influence inclusion decisions. Data were presented using narrative synthesis.ResultsThe search resulted in 4172 unique references, with 12 papers included in the review from 7 countries. Four were EMS studies, and eight Emergency Department with arrival via EMS. All studies used retrospective designs, with no interventional studies identified. Paediatric frequent EMS users were more likely to use services for medical reasons rather than trauma, including respiratory complaints, mental health and seizures, but data on gender and ethnicity were inconclusive and silent on socioeconomic status. There was no consistency in definitions of either a paediatric patient or of frequent use.ConclusionThe broad range of reasons for frequent use suggests that a single intervention is unlikely to be effective at addressing the causes of frequent use. There is a need for further research to better identify the underlying reasons for frequent EMS use among paediatric patients and to develop interventions in this population.

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“…Furthermore, mental health, specifically anxiety, and social isolation were identified by emergency medical service providers in the United Kingdom to have been contributing factors in changes to frequent use during the early stages of the COVID-19 pandemic (Scott et al, 2021). Systematic reviews of frequent ambulance service use identified that there was no single standard definition internationally for adult (Scott et al, 2014b) or paediatric patients (Scott et al, 2022) and a recent commentary on the topic by Brown et al (2019) called for standardised definitions of frequent use of ambulance services. The aim of this study was to develop a threshold of frequent use by evaluating at what point frequent ambulance service use deviated from expected usage, and once the threshold had been identified to compare call characteristics of frequent and non-frequent users.…”

Section: Introductionmentioning

confidence: 99%

Defining a threshold above which an adult can be considered to frequently use ambulance services: a retrospective cross-sectional study of emergency calls to an ambulance service in England

Scott

Pakpahan

Marlow³

et al. 2023

British Paramedic Journal

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Objective: There is no empirical definition of adult frequent use of ambulance services. This study aimed to define a threshold, and utilise this to explore characteristics of people frequently using services.Methods: This was a retrospective cross-sectional study in a single ambulance service in England. Routinely collected, pseudo-anonymised call- and patient-level data were collected for two months (January and June 2019). Incidents, defined as independent episodes of care, were analysed using a zero-truncated Poisson regression model to determine a suitable frequent-use threshold, with comparisons subsequently made between frequent and non-frequent users.Results: A total of 101,356 incidents involving 83,994 patients were included in the analysis. Two potentially appropriate thresholds were identified: five incidents per month (A); and six incidents per month (B). Threshold A produced 3137 incidents from 205 patients, with five patients likely false-positive identifications. Threshold B produced 2217 incidents from 95 patients, with no false-positive identifications but 100 false-negatives compared to threshold A. Regardless of threshold, frequent users compared to non-frequent users had relatively reduced service use between 08:00 and 15:00, were younger and were more likely to receive lower-priority responses (all p < 0.001). We identified several chief complaints indicative of increased frequent use, including chest pain, psychiatric/suicide attempt and abdominal pains/problems.Conclusions: We suggest a threshold of five incidents per month, with recognition that a small number of patients may be incorrectly identified as using ambulance services frequently. The rationale for this choice is discussed. This threshold may be applicable in wider UK settings and could be used for the routine automated identification of people using ambulance services frequently. The identified characteristics can help inform interventions. Future research should examine applicability of this threshold in other UK ambulance services and countries where patterns and determinants of frequent ambulance use may differ.

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Frequent Users of 9-1-1 Emergency Medical Services: Sign of Success or Symptom of Impending Failure?

Cited by 6 publications

References 19 publications

Identifying Frequent Health Care Users and Care Consumption Patterns: Process Mining of Emergency Medical Services Data

Identifying Frequent Health Care Users and Care Consumption Patterns: Process Mining of Emergency Medical Services Data

Paediatric frequent use of emergency medical services: a systematic review

Defining a threshold above which an adult can be considered to frequently use ambulance services: a retrospective cross-sectional study of emergency calls to an ambulance service in England

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