Non-conveyance in the ambulance service: a population-based cohort study in Stockholm, Sweden

Lederman, Jakob; Lindström, Veronica; Elmqvist, Carina; Löfvenmark, Caroline; Djärv, Therese

doi:10.1136/bmjopen-2019-036659

Cited by 38 publications

(47 citation statements)

References 25 publications

(47 reference statements)

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“…The decision-making process for non-conveyance appears to be complex and multifactorial [5]. EMS care providers' higher education level [3,8], EMS arrival time in the evening or at night [3,7,9,10], longer distance to a healthcare facility [7], rural area, younger patient age [3,10,11], low National Early Warning Score (NEWS2), and alcohol use increase the likelihood of nonconveyance [3]. A recent review showed that, after a non-conveyance decision, re-contact with the EMS or the ED, hospitalization and mortality rates varied a lot [5].…”

Section: Introductionmentioning

confidence: 99%

EMS non-conveyance: A safe practice to decrease ED crowding or a threat to patient safety?

et al. 2021

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Background The safety of the Emergency Medical Service’s (EMS’s) non-conveyance decision was evaluated by EMS re-contacts, primary health care or emergency department (ED) visits, and hospitalization within 48 h. The secondary outcome was 28-day mortality. Methods This cohort study used prospectively collected data on non-conveyed EMS patients from three different regions in Finland between June 1 and November 30, 2018. The Adjusted International Classification of Primary Care (ICPC2) as the reason for care was compared to hospital discharge diagnoses (ICD10). Multivariable logistic regressions were used to determine factors that were independently associated with adverse outcomes. Results are presented with adjusted odds ratios (aORs) together with 95% confidence intervals (CIs). Data regarding deceased patients were reviewed by the study group. Results Of the non-conveyed EMS patients (n = 11,861), 6.3% re-contacted the EMS, 8.3% attended a primary health care facility, 4.2% went to the ED, 1.6% were hospitalized, and 0.1% died 0–24 h after the EMS mission. The 0–24 h adverse event rate was higher than 24–48 h. After non-conveyance, 32 (0.3%) patients were admitted to an intensive care unit within 24 h. Primary non-urgent EMS mission (aOR 1.49; 95% CI 1.25 to 1.77), EMS arrival at night (aOR 1.82; 95% CI 1.58 to 2.09), ALS unit type vs BLS (aOR 1.43; 95% CI 1.16 to 1.77), rural area (aOR 1.74; 95% CI 1.51 to 1.99), and older patient age (aOR 1.41; 95% CI 1.20 to 1.66) were associated with subsequent primary health care visits (0–24 h). Conclusions Four in five non-conveyed patients did not have any re-contact in follow-up period. EMS non-conveyance seems to be a relatively safe method of focusing ED resources and avoiding ED crowding.

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Section: Introductionmentioning

confidence: 99%

EMS non-conveyance: A safe practice to decrease ED crowding or a threat to patient safety?

et al. 2021

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“…Patients in the non-transport group were also significantly younger compared to the total ambulance mission population. Other Nordic studies have described a higher probability of non-transport for women and younger patients [17,13]. On the other hand, a study from the Netherlands found no significant difference for gender, although the non-transport group was significantly younger (mean age 48.5 years vs 60.7 years for all missions) [16].…”

Section: Occurrence Of Non-transport Ambulance Missionsmentioning

confidence: 92%

“…A recent systematic review that included studies from North America, Europe, Australia, Asia, and Africa reported that non-transport rates varied from 4% to 94% [7]. Other studies have found non-transport rates of 40% in Finland [14], 38% in the UK [15], 26.2% in Netherlands [16], 15.5% in Australia [8], 13.8% in Sweden [17], and 12.9% in Denmark [18]. Comparatively, the non-transport rate in our study is low.…”

Section: Occurrence Of Non-transport Ambulance Missionsmentioning

confidence: 99%

The Safety of Non-Transport Decisions Made by Ambulance Personnel: A Retrospective Study of Subsequent Hospital Admission and 30-Day Mortality

Amundsen¹,

Myrmel²,

Assmus³

et al. 2021

Preprint

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BackgroundAmbulance missions do not always result in the patient being transported to a doctor or hospital after evaluation at the scene by ambulance personnel. Sometimes a patient is discharged at the scene but should have been transported for further examination and treatment. In this study, we aimed to identify and describe this group, and to investigate subsequent hospital admission within 72 hours and 30-day mortality, which may indicate the safety of leaving a patient at the scene after examination. MethodThis retrospective study was carried out in the Bergen health trust in western Norway and included ambulance missions from 2018. For each mission, we recorded the patient’s demographic information (age, gender, time of day), initial reason for contacting the emergency medical service (EMS), hospital admissions after non-transport, and time of death if within 30 days, in addition to some other variables. ResultsAmong 33,183 included acute and urgent ambulance missions, 7.3% of the patients were discharged at the scene after evaluation by ambulance personnel. The median age in this group was 47 years (IQR 28–70 years), compared to 64 years (IQR 39–80 years) for all included missions. Following a non-transport decision, 4.8% of the patients were admitted to a public hospital within 72 hours (median age, 59 years; IQR 35–76 years), with mental and behavioral disorders (ICD-10 chapter V) being the most common reason for admission (24.8%). The 30-day mortality rate following non-transport mission was 2.4%. In this group, the median age was 83 years (IQR 73–90 years), and the most common reasons for contacting EMS were breathing difficulties or lung diseases (25.4%), and injuries or fractures (18.6%). ConclusionOur present analysis revealed low rates of hospital admission within 72 hours, and 30-day mortality, among patients left at the scene following evaluation by ambulance personnel. These findings do not suggest an unsafe rate of non-transport in the Bergen EMS. There remains a need for further evaluation of the factors involved in the decision not to transport a patient, and the safety of these decisions.

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“…The study area had a population of approximately 2.2 million inhabitants [17]. The ambulance service is a publicly funded health care service, and approximately 210,000 ambulance assignments are performed annually, of which 14% ends in non-conveyance [18]. The ambulance service can be reached through the national emergency number (112), and all ambulance assignments are dispatched by the regional emergency medical communication centre.…”

Section: Settingmentioning

confidence: 99%

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

Lederman

Lindström

Elmqvist

et al. 2020

Preprint

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Background: Older adults (age ≥65 years) represent a significant proportion of all patients who are not transported to hospital after assessment by ambulance clinicians (non-conveyed patients). This study aimed to fill the knowledge gap in the understanding of the prevalence of older adult non-conveyed patients and investigate their characteristics and risk factors for subsequent and adverse events with those of younger non-conveyed patients comparatively.Methods: This population-based retrospective cohort study included all adult non-conveyed patients who availed the ambulance service of Region Stockholm, Sweden in 2015; they were age-stratified into two groups: 18–64 and ≥65 years. Inter-group differences in short-term outcomes (i.e. emergency department visits, hospitalisations, and mortality within 7 days following non-conveyance) were assessed using multivariate regression analyses.Results: Older adult patients comprised 48% of the 17,809 non-conveyed patients. Dispatch priority levels were generally lower among older non-conveyed patients than among younger patients. Non-conveyance among older patients occurred more often during daytime, and they were more frequently assessed by ambulance clinicians with nonspecific presenting symptoms. Approximately one in five older adults was hospitalised within 7 days following non-conveyance. Patients presenting with infectious symptoms had the highest mortality risk following non-conveyance. Oxygen saturation level <95% or systolic blood pressure >160 mmHg had significantly higher associations with hospitalisation within 7 days following non-conveyance in older adult patients.Conclusions: Older adult patients have an increased risk for adverse events following non-conveyance. In combination with a complex symptom presentation which proves difficult for dispatch operators and ambulance clinicians to identify, this risk raises questions on the patient safety of older adult non-conveyed patients.

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Non-conveyance in the ambulance service: a population-based cohort study in Stockholm, Sweden

Cited by 38 publications

References 25 publications

EMS non-conveyance: A safe practice to decrease ED crowding or a threat to patient safety?

EMS non-conveyance: A safe practice to decrease ED crowding or a threat to patient safety?

The Safety of Non-Transport Decisions Made by Ambulance Personnel: A Retrospective Study of Subsequent Hospital Admission and 30-Day Mortality

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

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