Outcomes in patients not conveyed by emergency medical services (EMS): a one-year prospective study

Abstract

Background The decision to not convey patients has become common in emergency medical services worldwide. A substantial proportion (12–51%) of the patients seen by emergency medical services are not conveyed by those services. The practice of non-conveyance is a result of the increasing and changing demands on the acute care system. Research focusing on the outcomes of the decision by emergency medical services to not convey patients is needed. Aim The aim was to describe outcomes (emergency department visits, admission to in-hospital intensive care units and mortality, all within seven days) and their association with the variables (sex, age, day of week, time of day, emergency signs and symptoms codes, triage level colour, and destination) for non-conveyed patients. Methods This was a prospective analytical study with consecutive inclusion of all patients not conveyed by emergency medical services. Patients were included between February 2016 and January 2017. The study was conducted in Region Örebro county, Sweden. The region consists of both rural and urban areas and has a population of approximately 295,000. The region had three ambulance departments that received approximately 30,000 assignments per year. Results The result showed that no patient received intensive care, and 18 (0.7%) patients died within seven days after the non-conveyance decision. Older age was associated with a higher risk of hospitalisation and death within seven days after a non-conveyance decision. Conclusions Based on the results of this one-year follow-up study, few patients compared to previous studies were admitted to the hospital, received intensive care or died within seven days. This study contributes insights that can be used to improve non-conveyance guidelines and minimise the risk of patient harm.

Pathways for older patients in acute situations and involved actors' experiences of decision-making in ambulatory care

“…The need for ED visits after non-conveyance increased for patients of all ages with symptoms of abdominal pain, fever, hypoglycaemia or when an ambulance assignment was carried out at night (116). The risk of mortality among patients of all ages who were non-conveyed has been described as low (0.2%-0.7%) (116,117) but higher than compared with those discharged from EDs (112,113). Older patients with symptoms of infections or mental disorders showed a higher 24hours mortality than younger patients (76).…”

“…Further, repeated ambulance contact, ED care and hospital admissions within 24-hours were higher among patients of all ages who were non-conveyed compared to those discharged from an ED. The risk further increased with age (76,112,117) and the occurrence of abnormal vital signs (112). However, the decision basis in acute situations involves multiple aspects.…”

“…However, the decision basis in acute situations involves multiple aspects. There are several aspects to the numbers of death and serious conditions among patients who where non-conveyed (112,117). For example, Höglund et al (2022) describes that 78% of those who died seven days after decisions of non-conveyance had an documented end-of-life decision and RNs or GP specialists present within the home during the ambulance personnel assessment (117).…”

“…There are several aspects to the numbers of death and serious conditions among patients who where non-conveyed (112,117). For example, Höglund et al (2022) describes that 78% of those who died seven days after decisions of non-conveyance had an documented end-of-life decision and RNs or GP specialists present within the home during the ambulance personnel assessment (117). The risks and complexity during decisions of care in acute situations highlights the need for further research.…”

“…Mortalitetsrisken för patienter i alla åldrar som 'ej medföljer' har bedömts vara låg, dvs 0.2% (116), detta är dock högre än för de patienter som skrivs hem från akutmottagningar (112,113). Det finns dock ett flertal orsaker till att patienter inte medföljer till sjukhus vilket försvårar jämförelsen med de som skrivs hem från akutmottagningar (112,117).…”