Patient and case characteristics associated with ‘no paramedic treatment’ for low-acuity cases referred for emergency ambulance dispatch following a secondary telephone triage: a retrospective cohort study

Abstract

BackgroundPredicting case types that are unlikely to be treated by paramedics can aid in managing demand for emergency ambulances by identifying cases suitable for alternative management pathways. The aim of this study was to identify the patient characteristics and triage outcomes associated with ‘no paramedic treatment’ for cases referred for emergency ambulance dispatch following secondary telephone triage.MethodsA retrospective cohort analysis was conducted of cases referred for emergency ambulance dispatch following secondary telephone triage between September 2009 and June 2012. Multivariable logistic regression modelling was used to identify explanatory variables associated with ‘no paramedic treatment’.ResultsThere were 19,041 cases eligible for inclusion in this study over almost three years, of which 8510 (44.7%) were not treated after being sent an emergency ambulance following secondary triage. Age, time of day, pain, triage guideline group, and comorbidities were associated with ‘no paramedic treatment’. In particular, cases 0–4 years of age or those with psychiatric conditions were significantly less likely to be treated by paramedics, and increasing pain resulted in higher rates of paramedic treatment.ConclusionsThis study highlights that case characteristics can be used to identify particular case types that may benefit from care pathways other than emergency ambulance dispatch. This process is also useful to identify gaps in the alternative care pathways currently available. These findings offer the opportunity to optimise secondary telephone triage services to support their strategic purpose of minimising unnecessary emergency ambulance demand and to match the right case with the right care pathway.

Changing role of EMS –analyses of non-conveyed and conveyed patients in Finland

“…Our study showed that patients in the conveyed group were more likely to suffer mental problems (P29), which is the same result as in previous studies [41,42]. This is surprising, because one study found that psychiatric patients rarely need any treatment [36]. On the other hand, there is evidence that EMS units often lack the skills required to manage these patients [41].…”

“…One reason might be the fact that primary care access is better in the daytime. Furthermore, one study found that EMS patients between 5 pm-7 am do not usually require much treatment [36].…”

“…Our model demonstrates that younger patients were more likely not to be conveyed than the elderly. Younger patients have previously been related to non-conveyed patients [11] and, for example, one study highlighted that patients under 25 years rarely needed any treatment [36]. On the other hand, a review found that geriatric patient groups were common among these patients and one fourth of the non-conveyed patients were 70 years or older [5].…”

Telephone triage performed by nurses reduces non‐urgent ambulance missions: A prospective observational pilot study in Finland

“…TA B L E 3 The service guidance and ICPC-2 categories in the frequent callers calls conducted in other countries. 3,7,16,17 In this study, the most common symptoms among these patients were general and unspecified symptoms, musculoskeletal symptoms, mental health problems and substance abuse, which highlight the essential difficulty of assessing these symptoms over the telephone.…”

The appropriateness of low-acuity cases referred for emergency ambulance dispatch following ambulance service secondary telephone triage: A retrospective cohort study

“…Some ambulance services estimate that up to half of patients calling for emergency medical assistance do not require an ambulance and could be better managed via alternative care pathways[1]. Patients with low-acuity conditions are increasingly calling emergency ambulances[2], forcing those requiring urgent medical attention to wait for resources responding from further away. In an effort to manage this increasing low-acuity demand[3] and the increasing costs of emergency ambulance response[4], some ambulance services have introduced secondary telephone triage to refer particular low-acuity cases to alternative care pathways[5–9].…”