Patient characteristics, triage utilisation, level of care, and outcomes in an unselected adult patient population seen by the emergency medical services: a prospective observational study

Abstract

Background: Crowding in the emergency department (ED) is a safety concern, and pathways to bypass the ED have been introduced to reduce the time to definitive care. Conversely, a number of low-acuity patients in the ED could be assessed by the emergency medical services (EMS) as requiring a lower level of care. The limited access to primary care in Sweden leaves the EMS nurse to either assess the patient as requiring the ED or to stay at the scene. This study aimed to assess patient characteristics and evaluate the initial assessment by and utilisation of the ambulance triage system and the appropriateness of non-transport decisions. Methods: A prospective observational study including 6712 patients aged ≥16 years was conducted. The patient records with 72 h of follow-up for non-transported patients were reviewed. Outcomes of death, time-critical conditions, complications within 48 h and final hospital assessment were evaluated. The Mann-Whitney U test, Fisher's exact test, and Spearman's rank correlation were used for statistical analysis. Results: The median patient age was 66 years, and the most common medical history was a circulatory diagnosis. Males received a higher priority from dispatchers and were more frequently assessed at the scene as requiring hospital care. A total of 1312 patients (19.7%) were non-transported; a history of psychiatric disorders or no medical history was more commonly noted among these patients. Twelve (0.9%) of the 1312 patients not transported were later admitted with time-critical conditions. Full triage was applied in 77.4% of the cases, and older patients were triaged at the scene as an 'unspecific condition' more frequently than younger patients. Overall, the 30-day mortality was 4.1% (n = 274). Conclusions: Age, sex, medical history, and presentation all appear to influence the initial assessment. A number of patients transported to ED could be managed at a lower level of care. A small proportion of the non-transported patients were later diagnosed with a time-critical condition, warranting improved assessment tools at the scene and education of the personnel focusing on the elderly population. These results may be useful in addressing resource allocation issues aiming at increasing patient safety.

Characteristics and outcomes of patients with dyspnoea as the main symptom, assessed by prehospital emergency nurses- a retrospective observational study

“…Overall, 11% of our study patients died within 30 days, similar to previous studies [8,9]. The mortality risk was almost three times as high as in the total EMS population in the same area [19]. Furthermore, our result also found that men with dyspnoea as the main symptom had a higher mortality rate than women.…”

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

“…Older adult non-conveyed patients were more often assessed with nonspeci c or vague presenting symptoms than younger patients. In line with a previous study [3], patients assessed with nonspeci c presenting symptoms were at higher risk of ED visits and hospitalisation following nonconveyance. Conditions related to infectious diseases, such as sepsis, have high mortality rates among older adult patients [28].…”

“…By its very nature, the ambulance service constitutes a high-risk patient safety environment which provides round-the-clock, year-round care services to a large volume of patients with a wide range of medical complaints [1]. Patients who are not transported to the hospital after an initial assessment by ambulance clinicians, that is, non-conveyed patients in the ambulance service [2], represent a signi cant and increasing proportion of those who seek ambulance services [3][4][5]. The research on patient outcome following non-conveyance is relatively sparse and, to some extent, has contrasting results [6][7][8].…”

“…Nonetheless, the differences related to the speci c characteristics of ambulance services are to be considered, including the use of non-conveyance guidelines and differences in the formal competence of the ambulance clinicians [9]. The general non-conveyance population are younger than the conveyed patients [3,6]; however, even within the relatively large group of non-conveyed patients, a signi cant proportion comprises patients older than 65 years. This group of older adult patients who have not been conveyed are described as a vulnerable group due to their characteristics of complex comorbidity, polypharmacy, and different symptom presentation [10,11].…”

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

“…In Finland, previous studies show that approximately 40% of EMS missions do not lead to patient conveyance to a healthcare facility [6,7]. Globally these rates are, for example, 19,7% in Sweden [8], 12,9% in Denmark [9], 37.5% in England [10], 26.2% in Netherlands [11] and 15.5% in Australia [12].…”