Pre-hospital assessment by a single responder: The Swedish ambulance nurse in a new role: A pilot study

Magnusson, Carl; Källenius, Christofer; Knutsson, Susanne; Herlitz, Johan; Axelsson, Christer

doi:10.1016/j.ienj.2015.09.001

Cited by 38 publications

(41 citation statements)

References 20 publications

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“…A variety of initial complaints and conditions was described [9, 29, 34, 38, 40, 45, 52, 56, 57, 61–63, 65, 74, 77–79, 85]. Most often, we found initial complaints and conditions classified as VI- diseases of the nervous system ( n = 16) or category XX - External causes of morbidity and mortality ( n = 16).…”

Section: Resultsmentioning

confidence: 80%

“…Non-conveyance rates for general patient populations ranged from 3.7% up to 93.7% [28, 30, 31, 33–35, 37, 38, 40–43, 45, 46, 49, 51, 52, 57, 60, 61, 64, 68, 77, 81]. Seventeen studies reported non-conveyance rates for specific patient populations.…”

Section: Resultsmentioning

confidence: 99%

“…For general patient populations, the age ranges from 14 up to 90 years [9, 29, 31, 33, 38–40, 45, 48, 50, 52, 54, 56, 62, 63, 65–67, 73, 74, 76, 78, 79, 85]. Twenty studies reported on patient gender: in ten studies the gender is predominantly male, in the other studies the population is predominantly female [9, 33, 38–40, 45, 48, 50, 52, 54, 62, 63, 65–67, 73, 74, 76, 79, 85]. Three studies described the geographic location of non-conveyed patients [33, 65, 74].…”

Section: Resultsmentioning

confidence: 99%

“…Most often, we found initial complaints and conditions classified as VI- diseases of the nervous system ( n = 16) or category XX - External causes of morbidity and mortality ( n = 16). For category VI the proportion of patients with these complaints and conditions ranged from 1.0%–29.0% [9, 29, 34, 38, 40, 45, 52, 56, 57, 61, 63, 65, 77–79, 85], for category XX the proportion ranged from 11.0%–68.5% [9, 29, 38, 40, 45, 52, 56, 57, 61–63, 65, 77–79, 85]. …”

Section: Resultsmentioning

confidence: 99%

“…Repeated access to the ED is measured in seventeen studies [8, 26, 37, 38, 40, 48, 50, 52, 56, 57, 62, 65–67, 75, 78, 90]. For general patient populations, the follow-up periods ranged from <24 h up to <7 days, and repeated access percentages varied from 4.6–7.0% (<24 h), 19.0% (<48 h), 6.4–25.8% (72 h) up to 8.1–80.1% (<7 days).…”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review

Ebben

Vloet

Speijers

et al. 2017

Scand J Trauma Resusc Emerg Med

128

208

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BackgroundThis systematic review aimed to describe non-conveyance in ambulance care from patient-safety and ambulance professional perspectives. The review specifically focussed at describing (1) ambulance non-conveyance rates, (2) characteristics of non-conveyed patients, (3) follow-up care after non-conveyance, (4) existing guidelines or protocols, and (5) influencing factors during the non-conveyance decision making process.MethodsWe systematically searched MEDLINE, PubMed, CINAHL, EMBASE, and reference lists of included articles, in June 2016. We included all types of peer-reviewed designs on the five topics. Couples of two independent reviewers performed the selection process, the quality assessment, and data extraction.ResultsWe included 67 studies with low to moderate quality. Non-conveyance rates for general patient populations ranged from 3.7%–93.7%. Non-conveyed patients have a variety of initial complaints, common initial complaints are related to trauma and neurology. Furthermore, vulnerable patients groups as children and elderly are more represented in the non-conveyance population. Within 24 h–48 h after non-conveyance, 2.5%–6.1% of the patients have EMS representations, and 4.6–19.0% present themselves at the ED. Mortality rates vary from 0.2%–3.5% after 24 h, up to 0.3%–6.1% after 72 h. Criteria to guide non-conveyance decisions are vital signs, ingestion of drugs/alcohol, and level of consciousness. A limited amount of non-conveyance guidelines or protocols is available for general and specific patient populations. Factors influencing the non-conveyance decision are related to the professional (competencies, experience, intuition), the patient (health status, refusal, wishes and best interest), the healthcare system (access to general practitioner/other healthcare facilities/patient information), and supportive tools (online medical control, high risk card).ConclusionsNon-conveyance rates for general and specific patient populations vary. Patients in the non-conveyance population present themselves with a variety of initial complaints and conditions, common initial complaints or conditions are related to trauma and neurology. After non-conveyance, a proportion of patients re-enters the emergency healthcare system within 2 days. For ambulance professionals the non-conveyance decision-making process is complex and multifactorial. Competencies needed to perform non-conveyance are marginally described, and there is a limited amount of supportive tools is available for general and specific non-conveyance populations. This may compromise patient-safety.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-017-0409-6) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 80%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review

Ebben

Vloet

Speijers

et al. 2017

Scand J Trauma Resusc Emerg Med

128

208

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Interrupted transport by the emergency medical service in stroke/transitory ischemic attack: A consequence of changed treatment routines in prehospital emergency care

et al. 2019

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Background The discovery that not all patients who call for the emergency medical service (EMS) require transport to hospital has changed the structure of prehospital emergency care. Today, the EMS clinician at the scene already distinguishes patients with a time‐critical condition such as stroke/transitory ischemic attack (TIA) from patients without. This highlights the importance of the early identification of stroke/TIA. Aim To describe patients with a final diagnosis of stroke/TIA whose transport to hospital was interrupted either due to a lack of suspicion of the disease by the EMS crew or due to refusal by the patient or a relative/friend. Methods Data were obtained from a register in Gothenburg, covering patients hospitalised due to a final diagnosis of stroke/TIA. The inclusion criterion was that patients were assessed by the EMS but were not directly transported to hospital by the EMS. Results Among all the patients who were assessed by the EMS nurse and subsequently diagnosed with stroke or TIA in 2015, the transport of 34 of 1,310 patients (2.6%) was interrupted. Twenty‐five of these patients, of whom 20 had a stroke and five had a TIA, are described in terms of initial symptoms and outcome. The majority had residual symptoms at discharge from hospital. Initial symptoms were vertigo/disturbed balance in 11 of 25 cases. Another three had symptoms perceived as a change in personality and three had a headache. Conclusion From this pilot study, we hypothesise that a fraction of patients with stroke/TIA who call for the EMS have their direct transport to hospital interrupted due to a lack of suspicion of the disease by the EMS nurse at the scene. These patients appear to have more vague symptoms including vertigo and disturbed balance. Instruments to identify these patients at the scene are warranted.

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Advanced paramedics and nurses can deliver safe and effective pre‐hospital and in‐hospital emergency care: An integrative review

2021

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Pre-hospital assessment by a single responder: The Swedish ambulance nurse in a new role: A pilot study

Cited by 38 publications

References 20 publications

A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review

A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review

Interrupted transport by the emergency medical service in stroke/transitory ischemic attack: A consequence of changed treatment routines in prehospital emergency care

Advanced paramedics and nurses can deliver safe and effective pre‐hospital and in‐hospital emergency care: An integrative review

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