Trends in demand for emergency ambulance services in Wiltshire over nine years: observational study

Wrigley, H; George, Steve; Smith, Helen; Snooks, Helen; Glasper, Alan; Thomas, Eileen

doi:10.1136/bmj.324.7338.646

Cited by 51 publications

(40 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Up to 40-50% of patient requests for emergency transport have been described as potentially avoidable or unnecessary, [44][45][46][47][48][49][50] being more suited to alternative community services, such as social, psychiatric or district nursing services 44 ; or warranting transport to the ED by alternative means such as a non-emergency vehicle. 49 However, it is difficult to define what is inappropriate or unnecessary, as clinicians and patients may hold different viewpoints.…”

Section: Appropriate Use and Accessibility To Alternative Servicesmentioning

confidence: 99%

Increasing utilisation of emergency ambulances

Lowthian¹,

Cameron²,

Stoelwinder³

et al. 2011

Aust. Health Review

180

161

View full text Add to dashboard Cite

Background. Increased ambulance utilisation is closely linked with Emergency Department (ED) attendances. Pressures on hospital systems are widely acknowledged with ED overcrowding reported regularly in the media and peer-reviewed literature. Strains on ambulance services are less well-documented or studied.Aims. To review the literature to determine the trends in utilisation of emergency ambulances throughout the developed world and to discuss the major underlying drivers perceived as contributing to this increase.Method. A search of online databases, search engines, peer-reviewed journals and audit reports was undertaken. Findings. Ambulance utilisation has increased in many developed countries over the past 20 years. Annual growth rates throughout Australia and the United Kingdom are similar. Population ageing, changes in social support, accessibility and pricing, and increasing community health awareness have been proposed as associated factors. As the extent of their contribution has not yet been established these factors were reviewed.Conclusion. The continued rise in utilisation of emergency ambulances is placing increasing demands on ambulance services and the wider health system, potentially compromising access, quality, safety and outcomes. A variety of factors may contribute to this increase and targeted strategies to reduce utilisation will require an accurate identification of the major drivers of demand.What is known about the topic? Ambulance utilisation is increasing annually throughout the developed world, with previous research suggesting numerous underlying factors. What does this paper add? These factors have not been previously synthesised in the international literature. This narrative review clearly articulates the underlying problems. What are the implications for practitioners? This paper outlines the need for further research of the causes of increased emergency ambulance utilisation, to enable the development of appropriate strategies to manage demand in the future.

show abstract

Section: Appropriate Use and Accessibility To Alternative Servicesmentioning

confidence: 99%

Increasing utilisation of emergency ambulances

Lowthian¹,

Cameron²,

Stoelwinder³

et al. 2011

Aust. Health Review

180

161

View full text Add to dashboard Cite

show abstract

“…6,7 With increasing sophistication of prehospital care, this 'one size fits all' response is becoming unsustainable and misallocates skilled resources to low-acuity patients, impacting on the availability and response times for more urgent cases. 6,[8][9][10][11][12][13][14] Furthermore, transporting low-acuity patients to hospital emergency departments (ED) may delay more appropriate care, such as primary medical or nursing care, from being implemented.…”

Section: Introductionmentioning

confidence: 99%

A novel approach for managing the growing demand for ambulance services by low-acuity patients

Eastwood¹,

Morgans²,

Smith³

et al. 2016

Aust. Health Review

View full text Add to dashboard Cite

Objective. The aim of the present study was to describe the Ambulance Victoria (AV) secondary telephone triage service, called the Referral Service (RS), for low-priority patients calling triple zero. This service provides alternatives to ambulance dispatch, such as doctor or nurse home visits.Methods. A descriptive epidemiological review of all the cases managed between 2009 and 2012 was conducted, using data from AV case records, the Victorian Admitted Episodes Dataset and the Australian Bureau of Statistics. Cases were reviewed for patient demographics, condition, final disposition and RS outcome.Results. In all, 107 148 cases were included in the study, accounting for 10.3% of the total calls for ambulance attendance. Median patient age was 54 years and 55% were female. Geographically based socioeconomic status was associated with the rate of calls to the RS (r = -0.72; 95% confidence interval CI -0.104, -0.049; P < 0.001). Abdominal pain and back symptoms were the most common patient problems. Although 68% of patients were referred to the emergency department, only 27.6% of the total cases were by emergency ambulance; the remainder were diverted to non-emergency ambulance or the patient's own private transport. The remaining 32% of cases were referred to alternative service providers or given home care advice.Conclusions. This paper describes the use of an ongoing secondary triage service, providing an effective strategy for managing emergency ambulance demand.What is known about the topic? Some calls to emergency services telephone numbers for ambulance assistance consist of cases deemed to be low-acuity that could potentially be better managed in the primary care setting. The demand on ambulance resources is increasing each year. Secondary telephone triage systems have been trialled in ambulance services in the US and UK with minimal success in terms of overall impact on ambulance resourcing. What does this paper add? This study describes a model of secondary telephone triage in the ambulance setting that has provided an effective way to divert patients to more suitable forms of health care to meet their needs. What are the implications for practitioners? The implications for practitioners are vast. Some of the issues that currently face paramedics include: fatigue because of high workloads; skills decay because of a lack of exposure to patients requiring intervention with skills the paramedics have, as well as a lack of time for paramedics to practice these skills during their downtime; and decreasing job satisfaction linked to both these factors. Implications for patients include quicker response times because more ambulances will be available to respond and increased patient safety because of decreased fatigue and higher skill levels in paramedics.

show abstract

“…We hypothesise that the increase in interaction here is a result of more frequent paramedic visits to the GP surgery compared to other community pharmacies. For example, Wrigley et al (2002) found that over a 9-year period GPs within a single NHS trust either made, or were present for, around 15% of the calls to emergency ambulance services. In addition, a review of paramedic activities in the UK noted that paramedics are increasingly working within GP practices and primary care settings (Woollard, 2006) which may further explain this finding.…”

Section: Discussionmentioning

confidence: 99%