Patient Perspectives on EMS Alternate Destination Models

Munjal, Kevin; Shastry, Siri; Loo, George; Reid, D. D.; Grudzen, Corita; Shah, Manish N.; Chapin, Hugh H.; First, Brandon; Sirirungruang, Sasilada; Alpert, Erin; Chason, Kevin; Richardson, Lynne D.

doi:10.1080/10903127.2016.1182604

Cited by 25 publications

(18 citation statements)

References 33 publications

(31 reference statements)

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“…Further, the three categories allowed for evaluation of linear effects versus simply dichotomizing age. The oldest category of ≥80 years was selected based on previous EMS research 19 and limitations of the sample size. A Cochrane Armitage test for linear trend was used to assess the crude relationship between increasing age and arrival to the ED via EMS.…”

Section: Methodsmentioning

confidence: 99%

“…Age greater than 80 years was used to classify subjects as oldest-old based on the available sample size and previous EMS research. 19 Simply dichotomizing age based on the traditional cutoff of 65 years would not allow for such comparisons. However, the sample size limited the ability to use smaller age strata and still have the ability to adjust for relevant covariates.…”

Section: Limitationsmentioning

confidence: 99%

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The Effect of Older Age on EMS Use for Transportation to an Emergency Department

Jones

Wasserman

et al. 2017

Prehosp. Disaster med.

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Introduction: Previous studies have found that older adults are more likely to use Emergency Medical Services (EMS) than younger adults, but the reasons for this remain understudied. Hypothesis/Problem: This study aimed to determine if older age is associated with using EMS for transportation to an emergency department (ED) after controlling for confounding variables. Methods: A cross-sectional survey study was conducted at a large academic medical center. Data on previous medical history, chief complaint, self-perceived illness severity, demographic information, and mode of arrival to the ED were collected on all subjects. Those who arrived to the ED via EMS also were asked reasons why they opted to call an ambulance for their illness/injury. Descriptive statistics were used to quantify survey responses, and multivariable regression was used to assess the independent effect of age on mode of ED arrival. Results: Data from 1,058 subjects were analyzed, 449 (42%) of whom arrived to the ED via EMS. Compared to adults <55 years, the unadjusted prevalence ratio for the association between age and EMS use was 1.18 (95% CI, 0.96-1.45) for subjects 55-79 years and 1.54 (95% CI, 1.18-2.02) for subjects ≥80 years. After adjustment for confounding variables, age remained a statistically significant risk factor for EMS use (P < .05). Conclusion: Older age is an independent risk factor for transportation to the ED via ambulance; however, this effect is attenuated by number of chronic medical conditions and history of depression. Additional research is needed to account for confounders unmeasured in this study and to elucidate reasons for the increased frequency of EMS use among older adults.Jones CMC, Wasserman EB, Li T, Amidon A, Abbott M, Shah MN. The effect of older age on EMS use for transportation to an emergency department. Prehosp Disaster Med. 2017;32(3):261-268. IntroductionIt is estimated that 38% of all ambulance transports are for adults aged 65 or older, despite only comprising 13% of the population.1,2 The size of the older adult population is growing. By the year 2050, it is estimated that there will be over 84 million adults 65 years of age and older in the United States.3 This increase in the older adult population has the potential to place strains on the ambulance-based Emergency Medical Services (EMS) system as the rate of EMS utilization among older adults is nearly four-times higher than adults less than age 65 (167 per 1,000 versus 39 per 1,000).

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Section: Methodsmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

The Effect of Older Age on EMS Use for Transportation to an Emergency Department

Jones

Wasserman

et al. 2017

Prehosp. Disaster med.

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“…Notre cas témoigne que la télémédecine apporte des informations supplémentaires au médecin régulateur pour optimiser la prise en charge des patients, notamment dans les cas de douleurs thoraciques atypiques, ou encore dans l'optimisation de la gestion des équipes de secours [10][11][12]. Ce système permet également de rattraper des erreurs de jugement, notamment dans des régulations difficiles, où l'expérience et la sensibilité du médecin décideur ne suffit malheureusement pas toujours à prendre la bonne décision.…”

Section: Discussionunclassified

Impact de la télémédecine sur la régulation d'un malaise

Dubocage

Delelis-Fanien

Guenezan

2018

Ann. Fr. Med. Urgence

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“…Although these options have advantages in terms of efficiency, few studies have been conducted in which patients were asked about how they reacted to an alternative level of care to the ED, when seeking help for non-urgent conditions (Jones, Wasserman, Li, & Shah, 2015; Munjal et al, 2016). Thus, the proportion of patients supporting transportation to an alternative destination has been reported to range between 58% (Munjal et al, 2016) and 69% (Jones et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

“…Thus, the proportion of patients supporting transportation to an alternative destination has been reported to range between 58% (Munjal et al, 2016) and 69% (Jones et al, 2015). To our knowledge, no one has ever asked about the patient’s lived experiences of the early chain of healthcare in this particular situation.…”

Section: Introductionmentioning

confidence: 99%

Trust in the early chain of healthcare: lifeworld hermeneutics from the patient’s perspective

Boysen

Nyström

Christensson

et al. 2017

International Journal of Qualitative Studies on Health and Well

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Purpose: Patients must be able to feel as much trust for caregivers and the healthcare system at the healthcare centre as at the emergency department. The aim of this study is to explain and understand the phenomenon of trust in the early chain of healthcare, when a patient has called an ambulance for a non-urgent condition and been referred to the healthcare centre.Method: A lifeworld hermeneutic approach from the perspective of caring science was used. Ten patients participated: seven female and three male. The setting is the early chain of healthcare in south-western Sweden.Results: The findings show that the phenomenon of trust does not automatically involve medical care. However, attention to the patient’s lifeworld in a professional caring relationship enables the patient to trust the caregiver and the healthcare environment. It is clear that the “voice of the lifeworld” enables the patient to feel trust.Conclusion: Trust in the early chain of healthcare entails caregivers’ ability to pay attention to both medical and existential issues in compliance with the patient’s information and questions. Thus, the patient must be invited to participate in assessments and decisions concerning his or her own healthcare, in a credible manner and using everyday language.

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Patient Perspectives on EMS Alternate Destination Models

Cited by 25 publications

References 33 publications

The Effect of Older Age on EMS Use for Transportation to an Emergency Department

The Effect of Older Age on EMS Use for Transportation to an Emergency Department

Impact de la télémédecine sur la régulation d'un malaise

Trust in the early chain of healthcare: lifeworld hermeneutics from the patient’s perspective

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