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Noble AJ, Dixon P, Mathieson A, Ridsdale L, Morgan M, McKinlay A, Dickson J, Goodacre S, Jackson M, Morris B, Hughes D, Marson A, Holmes E. Developing feasible person-centred care alternatives to emergency department responses for adults with epilepsy: a discrete choice analysis mixed-methods study. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-158. [PMID: 39206517 DOI: 10.3310/hkqw4129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Background Calls have been made for paramedics to have some form of care pathway that they could use to safely divert adults with epilepsy away from emergency departments and instigate ambulatory care improvements. Different configurations are possible. To know which to prioritise for implementation/evaluation, there is a need to determine which are acceptable to service users and likely National Health Service-feasible. Objective(s) (1) Identify configurations being considered, (2) understand service users' views of them and current provision, (3) identify what sort of care service users want and (4) determine which configuration(s) is considered to achieve optimal balance in meeting users' preference and being National Health Service-feasible. Design Service providers were surveyed to address objective 1. Interviews with service users addressed objective 2. Objective 3 was addressed by completing discrete choice experiments. These determined users' care preferences for different seizure scenarios. Objective 4 was addressed by completing 'knowledge exchange' workshops. At these, stakeholders considered the findings on users' stated preferences and judged different pathway configurations against Michie's 'acceptability, practicability, effectiveness, affordability, side-effects and equity' feasibility criteria. Setting This project took place in England. The survey recruited representatives from neurology and neuroscience centres and from urgent and emergency care providers. For the interviews, recruitment occurred via third-sector support groups. Recruitment for discrete choice experiments occurred via the North West Ambulance Service NHS Trust and public advert. Workshop participants were recruited from neurology and neuroscience centres, urgent and emergency care providers, support groups and commissioning networks. Participants Seventy-two services completed the survey. Interviews were conducted with 25 adults with epilepsy (and 5 relatives) who had emergency service contact in the prior 12 months. Discrete choice experiments were completed by 427 adults with epilepsy (and 167 relatives) who had ambulance service contact in the prior 12 months. Workshops were completed with 27 stakeholders. Results The survey identified a range of pathway configurations. They differed in where they would take the patient and their potential to instigate ambulatory care improvements. Users had been rarely consulted in designing them. The discrete choice experiments found that users want a configuration of care markedly different to that offered. Across the seizure scenarios, users wanted their paramedic to have access to their medical records; for an epilepsy specialist (e.g. an epilepsy nurse, neurologist) to be available to advise; for their general practitioner to receive a report; for the incident to generate an appointment with an epilepsy specialist; for the care episode to last < 6 hours; and there was a pattern of preference to avoid conveyance to emergency departments and stay where they were. Stakeholders judged this configuration to be National Health Service-feasible within 5-10 years, with some elements being immediately deployable. Limitations The discrete choice experiment sample was broadly representative, but those reporting recent contact with an epilepsy specialist were over-represented. Conclusions Users state they want a configuration of care that is markedly different to current provision. The configuration they prefer was, with support and investment, judged to likely be National Health Service-feasible. The preferred configuration should now be developed and evaluated to determine its actual deliverability and efficacy. Study registration The study is registered as researchregistry4723. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/05/62) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 24. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Adam J Noble
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Pete Dixon
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Amy Mathieson
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - Leone Ridsdale
- Department of Basic and Clinical Neuroscience, King's College London, London, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Alison McKinlay
- Institute of Pharmaceutical Science, King's College London, London, UK
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Jon Dickson
- Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, UK
| | - Steve Goodacre
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Mike Jackson
- North West Ambulance Service NHS Trust, Bolton, UK
| | - Beth Morris
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Dyfrig Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Anthony Marson
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Emily Holmes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
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Jones D, Capstick A, Faisal M, Frankland J. The impact of dementia education on student paramedics' preparedness to care, knowledge, confidence and attitudes towards dementia: an analytic survey. Br Paramed J 2023; 8:9-17. [PMID: 37284607 PMCID: PMC10240862 DOI: 10.29045/14784726.2023.6.8.1.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Background Paramedics play a vital role in the emergency healthcare of people living with dementia. People with dementia often have complex needs, posing challenges for paramedics. Paramedics often lack the confidence and skills to assess people with dementia appropriately, and receive little, if any, dementia education. Aims To evaluate the impact of dementia education on student paramedics' preparedness to care, knowledge, confidence and attitudes towards dementia. Methods A 6-hour education programme on dementia was developed, implemented and evaluated. A pre-test-post-test design using self-completion validated questionnaires was used, to evaluate first-year undergraduate student paramedics' knowledge, confidence and attitudes towards dementia, as well as their preparedness to care for people with dementia. Results A total of 43 paramedic students attended the education programme, with 41 fully completed questionnaires being collected pre-training and 32 post-training. Students reported feeling significantly more preparedness to care for people with dementia after the education session (p < 0.001). They felt their knowledge (100%), confidence (87.5%) and attitudes (87.5%) towards dementia had significantly increased following the education session. Using validated measures, the impact of education was found to be the highest on dementia knowledge (13.8 vs 17.5; p < 0.001) and on confidence (29.14 vs 34.06; p = 0.001), with only a minimal effect on attitudes (101.5 vs 103.4; p = 0.485). The education programme itself was well-evaluated. Conclusion As paramedics are central to the emergency healthcare of people living with dementia, it is essential that the emerging paramedic workforce is equipped with the knowledge, attitudes and confidence to provide quality care for this population. We need to ensure dementia education is embedded in undergraduate curricula, and that consideration is given to the subjects, level and pedagogic approach taken to ensure positive outcomes are maximised.
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The prehospital management of ambulance-attended adults who fell: A scoping review. Australas Emerg Care 2023; 26:45-53. [PMID: 35909044 DOI: 10.1016/j.auec.2022.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The ageing population is requiring more ambulance attendances for falls. This scoping review aimed to map and synthesise the evidence for the prehospital management of Emergency Medical Services (EMS) attended adult patients who fall. METHODS The Joanna Briggs Institute methods for scoping reviews were used. Six databases were searched (Medline, Scopus, CINAHL, Cochrane, EMBASE, ProQuest), 1st August 2021. Included sources reported: ambulance attended (context), adults who fell (population), injuries, interventions or disposition data (concept). Data were narratively synthesised. RESULTS One-hundred and fifteen research sources met the inclusion criteria. Detailed information describing prehospital delivered EMS interventions, transport decisions and alternative care pathways was limited. Overall, adults< 65 years were less likely than older adults to be attended repeatedly and/or not transported. Being male, falling from height and sustaining severe injuries were associated with transport to major trauma centres. Older females, falling from standing/low height with minor injuries were less likely to be transported to major trauma centres. CONCLUSION The relationship between patient characteristics, falls and resulting injuries were well described in the literature. Other evidence about EMS management in prehospital settings was limited. Further research regarding prehospital interventions, transport decisions and alternative care pathways in the prehospital setting is recommended.
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Mills B, Hill M, Miles A, Smith E, Afrifa-Yamoah E, Reid D, Rogers S, Sim M. Calling an ambulance for non-emergency medical situations: Results of a cross-sectional online survey from an Australian nationally representative sample. Emerg Med Australas 2023; 35:133-141. [PMID: 36113863 PMCID: PMC10087376 DOI: 10.1111/1742-6723.14086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/10/2022] [Accepted: 08/24/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To investigate the Australian general public's perception of appropriate medical scenarios that warrants a call to an emergency ambulance. METHODS An online survey asked participants to identify the likely medical treatment pathway they would take for 17 hypothetical medical scenarios. The number and type of non-emergency scenarios (n = 8) participants incorrectly suggested were appropriate to place a call for an emergency ambulance were calculated. Participants included Australian residents (aged >18 years) who had never worked as an Australian registered medical doctor, nurse or paramedic. RESULTS From a sample of 5264 participants, 40% suggested calling an emergency ambulance for a woman in routine labour was appropriate. Other medical scenarios which were most suggested by participants to warrant an emergency ambulance call was 'Lego in ear canal' (11%), 'Older person bruising' (8%) and 'Flu' (7%). Women, people aged 56+ years, those without a university qualification, with lower household income and with lower emotional wellbeing were more likely to suggest calling an emergency ambulance was appropriate for non-emergency scenarios. CONCLUSIONS Although emergency healthcare system (EHS) capacity not increasing at the same rate as demand is the biggest contributor to EHS burden, non-urgent medical situations for which other low-acuity healthcare pathways may be appropriate does play a small role in adding to the overburdening of the EHS. This present study outlines a series of complaints and demographic characteristics that would benefit from targeted educational interventions that may aid in alleviating ambulance service attendances to low-acuity callouts.
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Affiliation(s)
- Brennen Mills
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Michella Hill
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Alecka Miles
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Erin Smith
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Eben Afrifa-Yamoah
- School of Science, Edith Cowan University, Perth, Western Australia, Australia
| | - David Reid
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Shane Rogers
- School of Arts and Humanities, Edith Cowan University, Perth, Western Australia, Australia
| | - Moira Sim
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
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Moore HE, Siriwardena AN, Gussy M, Spaight R. Mental health emergencies attended by ambulances in the United Kingdom and the implications for health service delivery: A cross-sectional study. J Health Serv Res Policy 2022; 28:138-146. [PMID: 35975884 DOI: 10.1177/13558196221119913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE In the context of increasing demand for ambulance services, emergency mental health cases are among the most difficult for ambulance clinicians to attend, partly because the cases often involve referring patients to other services. We describe the characteristics of mental health emergencies in the East Midlands region of the United Kingdom. We explore the association between 999 (i.e. emergency) call records, the clinical impressions of ambulance clinicians attending emergencies and the outcomes of ambulance attendance. We consider the implications of our results for optimizing patient care and ambulance service delivery. METHODS We conducted a retrospective observational study of records of all patients experiencing mental health emergencies attended by ambulances between 1 January 2018 and 31 July 2020. The records comprised details of 103,801 '999' calls (Dispatch), the preliminary diagnoses by ambulance clinicians on-scene (Primary Clinical Impression) and the outcomes of ambulance attendance for patients (Outcome). RESULTS A multinomial regression analysis found that model fit with Outcome data was improved with the addition of Dispatch and Primary Clinical Impression categories compared to the fit for the model containing only the intercept and Outcome categories (Chi-square = 18,357.56, df = 180, p < 0.01). Dispatch was a poor predictor of Primary Clinical impression. The most common predictors of Outcome care pathways other than 'Treated and transported' were records of respiratory conditions at Dispatch and anxiety reported by clinicians on-scene. CONCLUSIONS Drawing on the expertise of mental health specialists may help '999' dispatchers distinguish between physical and mental health emergencies and refer patients to appropriate services earlier in the response cycle. Further investigation is needed to determine if training Dispatch operatives for early triage and referral can be appropriately managed without compromising patient safety.
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Affiliation(s)
| | - Aloysius Niroshan Siriwardena
- Professor of Primary and Pre-hospital Healthcare, Community and Health Research Unit, School of Health and Social Care, 4547University of Lincoln, Lincoln, UK
| | - Mark Gussy
- Global Professor of Rural Health and Social Care, Lincoln Institute of Rural Health, 4547University of Lincoln, Lincoln, UK
| | - Robert Spaight
- Head of Clinical Research and Audit, 9819East Midlands Ambulance NHS Trust, Nottinghamshire, UK
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Patton A, O'Donnell C, Keane O, Henry K, Crowley D, Collins A, Redmond E, Glynn N, Dunne M, Deasy C. The Alternative Pre-hospital Pathway team: reducing conveyances to the emergency department through patient centered Community Emergency Medicine. BMC Emerg Med 2021; 21:138. [PMID: 34794391 PMCID: PMC8601091 DOI: 10.1186/s12873-021-00536-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/13/2021] [Indexed: 11/23/2022] Open
Abstract
Background Internationally increasing demand for emergency care is driving innovation within emergency services. The Alternative Pre-Hospital Pathway (APP) Team is one such Community Emergency Medicine (CEM) initiative developed in Cork, Ireland to target low acuity emergency calls. In this paper the inception of the APP Team is described, and an observational descriptive analysis of the APP Team’s service data presented for the first 12 months of operation. The aim of this study is to describe and analyse the APP team service. Methods The APP Team, consisting of a Specialist Registrar (SpR) in Emergency Medicine (EM) and an Emergency Medical Technician (EMT) based in Cork, covers a mixed urban and rural population of approximately 300,000 people located within a 40-min drive time of Cork University Hospital. The team are dispatched to low acuity 112/999 calls, aiming to provide definitive care or referring patients to the appropriate community or specialist service. A retrospective analysis was performed of the team’s first 12 months of operation using the prospectively maintained service database. Results Two thousand and one patients were attended to with a 67.8% non-conveyance rate. The median age was 62 years, with 33.0% of patients aged over 75 years. For patients over 75 years, the non-conveyance rate was 62.0%. The average number of patients treated per shift was 7. Medical complaints (319), falls (194), drug and alcohol related presentations (193), urological (131), and respiratory complaints (119) were the most common presentations. Conclusion Increased demand for emergency care and an aging population is necessitating a re-design of traditional models of emergency care delivery. We describe the Alternative Pre-Hospital Pathway service, delivered by an EMT and an Emergency Medicine SpR responding to low acuity calls. This service achieved a 68% non-conveyance rate; our data demonstrates that a community emergency medicine outreach team in collaboration with the National Ambulance Service offering Alternative Pre-Hospital Pathways is an effective model for reducing conveyances to hospital. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-021-00536-x.
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Affiliation(s)
- Andrew Patton
- Emergency Department, Cork University Hospital, Wilton, Cork, Ireland.
| | - Cathal O'Donnell
- Medical Directorate, National Ambulance Service, Health Service Executive, Limerick, Ireland
| | - Owen Keane
- Emergency Department, Cork University Hospital, Wilton, Cork, Ireland
| | - Kieran Henry
- National Ambulance Service, Health Service Executive, Cork, Ireland
| | - Donal Crowley
- National Ambulance Service, Health Service Executive, Cork, Ireland
| | - Adrian Collins
- National Ambulance Service, Health Service Executive, Cork, Ireland
| | - Eoghan Redmond
- School of Medicine, University College Cork, Cork, Ireland
| | - Nicky Glynn
- National Ambulance Service, Health Service Executive, Cork, Ireland
| | - Martin Dunne
- National Ambulance Service, Health Service Executive, Cork, Ireland
| | - Conor Deasy
- Emergency Department, Cork University Hospital, Wilton, Cork, Ireland
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Moafa HN, van Kuijk SMJ, Moukhyer ME, Alqahtani DM, Haak HR. Non-Conveyance Due to Patient-Initiated Refusal in Emergency Medical Services: A Retrospective Population-Based Registry Analysis Study in Riyadh Province, Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179252. [PMID: 34501841 PMCID: PMC8431479 DOI: 10.3390/ijerph18179252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 11/26/2022]
Abstract
This research study aimed to investigate the association between demographic and operational factors and emergency medical services (EMS) missions ending in non-conveyance (NC) due to patient-initiated refusal (PIR). We conducted a retrospective population-based registry study by analyzing 67,620 EMS missions dispatched to the scene during 2018 in the Riyadh province. First, the number and percentages of conveyances statuses were calculated. Then, using crude and adjusted linear and logistic regression analysis, we determined which characteristics were predictors of NC due to PIR. We found that 23,991 (34.4%) of missions ended in NC due to PIR, and 5969 ended in EMS-initiated refusal (8.6%). NC rates due to PIR were higher for women, adults, for missions in Riyadh city, during nighttime, for medical emergencies, and for advanced life support (ALS) crews. We also found the following additional predictors significantly associated with the odds of NC due to PIR in crude regression analyses: age category, geographical location, EMS-shift, time of call, emergency type, and response time. We conclude that the NC rate represents half of all missions for patients requesting EMS, and the rate in Riyadh city has increased compared to previous studies. Most NC cases occur for the highest urgency level of medical emergency type in Riyadh city during the nighttime with ALS crews. NC due to PIR involves younger patients more than elderly, and females more than males. This study’s findings have provided empirical evidence that indicate that conducting further studies involving EMS providers, patients, and the public to identify precise and detailed reasons is required.
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Affiliation(s)
- Hassan N. Moafa
- Department of Health Services Management, Faculty of Public Health and Tropical Medicine, Jazan University, Jazan 82817 2820, Saudi Arabia
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, 6229 GT Maastricht, The Netherlands;
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands;
- Correspondence: or ; Tel.: +31-615-373-733
| | - Sander M. J. van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands;
| | - Mohammed E. Moukhyer
- Department of Academic Development and Quality, Faculty of Applied Medical Sciences, Jazan University, Jazan 82511, Saudi Arabia;
| | - Dhafer M. Alqahtani
- Department of Electronic Transaction Management, Saudi Red Crescent Authority, Ministry of Health, Riyadh 13251-8261, Saudi Arabia;
| | - Harm R. Haak
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, 6229 GT Maastricht, The Netherlands;
- Department of Internal Medicine, Maxima Medisch Centre, 5631 BM Eindhoven, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
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Deakin CD, Quartermain A, Ellery J. Do patients suffering an out-of-hospital cardiac arrest present to the ambulance service with symptoms in the preceding 48 h? EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 6:308-314. [PMID: 31584640 DOI: 10.1093/ehjqcco/qcz054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/09/2019] [Accepted: 09/29/2019] [Indexed: 01/11/2023]
Abstract
AIMS In-hospital cardiac arrests are often preceded by a period of physiological deterioration that has often gone unnoticed. We proposed that the same might be true for out-of-hospital cardiac arrests (OHCAs) where ambulance crews leave patients at home who then subsequently go on to suffer a cardiac arrest. METHODS AND RESULTS We identified all OHCA over a 12-month period that had been seen and assessed by an ambulance crew within the 48 h preceding their cardiac arrest. We retrospectively calculated the patient's NEWS2 score at the time of their initial assessment as a marker of their physiological status and need for hospital admission. Of 1960 OHCA patients, 184 (9.4%) had been assessed by ambulance crews within the preceding 48 h. Excluding those who had been taken to hospital (and then discharged), declined hospital conveyance or were on end-of-life care pathways, 79 (56% of total) were left at home through crew discretion. Thirty-four out of 79 (43%) patients not conveyed had either a NEWS score of 3 in a single parameter or a score of ≥5, which in hospital would mandate an urgent medical review. The most overlooked observation was respiratory rate. CONCLUSIONS In total, 1.7% of all OHCA had been assessed in the previous 48 h and inappropriately left at home by ambulance crews. This represents a missed opportunity to avert cardiac arrest. NEWS scoring has the potential to improve pre-hospital triage of these patients and avoid missing the deteriorating patient.
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Affiliation(s)
- Charles D Deakin
- South Central Ambulance Service NHS Foundation Trust, Otterbourne, Winchester SO21 2RU, UK.,University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Albert Quartermain
- University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Jacob Ellery
- South Central Ambulance Service NHS Foundation Trust, Otterbourne, Winchester SO21 2RU, UK
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Jaffe E, Sonkin R, Strugo R, Zerath E. Evolution of emergency medical calls during a pandemic - An emergency medical service during the COVID-19 outbreak. Am J Emerg Med 2021; 43:260-266. [PMID: 33008702 PMCID: PMC7318958 DOI: 10.1016/j.ajem.2020.06.039] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/13/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Emergency Medical Services (EMS) are expected to be affected by a pandemic outbreak. However, the available data about trends and extents of these effects is limited. METHODS We analyzed numbers of ambulance calls for all 136 diagnosis codes used by Magen David Adom (MDA), Israel's national EMS during 121 days between January 01 and April 30, 2020. RESULTS There was an increase in calls for COVID-19 symptoms (cough, fever, throat pain). This trend followed the same shape as the curve for confirmed COVID-19 patients. Trends were found to increase for calls not followed by transport to the hospital as well as in calls for mental or psychiatric causes. Simultaneously, there was a decrease in calls for cardiovascular issues, pneumonia, and all injuries. CONCLUSION Understanding these correlations may allow better preparedness of the EMS and a better response towards the public needs in the period of an epidemic or a pandemic.
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Affiliation(s)
- Eli Jaffe
- Magen David Adom, Tel Aviv-Jaffo, Israel; Ben Gurion University of the Negev, Beer Sheva, Israel
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Schehadat MS, Scherer G, Groneberg DA, Kaps M, Bendels MHK. Outpatient care in acute and prehospital emergency medicine by emergency medical and patient transport service over a 10-year period: a retrospective study based on dispatch data from a German emergency medical dispatch centre (OFF-RESCUE). BMC Emerg Med 2021; 21:29. [PMID: 33750317 PMCID: PMC7941891 DOI: 10.1186/s12873-021-00424-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of operations by the German emergency medical service almost doubled between 1994 and 2016. The associated expenses increased by 380% in a similar period. Operations with treatment on-site, which retrospectively proved to be misallocated (OFF-Missions), have a substantial proportion of the assignment of the emergency medical service (EMS). Besides OFF-Missions, operations with patient transport play a dominant role (named as ON-Missions). The aim of this study is to work out the medical and economic relevance of both operation types. METHODS This analysis examined N = 819,780 missions of the EMS and patient transport service (PTS) in the catchment area of the emergency medical dispatch centre (EMDC) Bad Kreuznach over the period from 01/01/2007 to 12/31/2016 in terms of triage and disposition, urban-rural distribution, duration of operations and economic relevance (p < .01). RESULTS 53.4% of ON-Missions are triaged with the indication non-life-threatening patient transport; however, 63.7% are processed by the devices of the EMS. Within the OFF-Mission cohort, 78.2 and 85.8% are triaged or dispatched for the EMS. 74% of all ON-Missions are located in urban areas, 26% in rural areas; 81.3% of rural operations are performed by the EMS. 66% of OFF-Missions are in cities. 93.2% of the remaining 34% of operations in rural locations are also performed by the EMS. The odds for both ON- and OFF-Missions in rural areas are significantly higher than for PTS (ORON 3.6, 95% CI 3.21-3.30; OROFF 3.18, 95% CI 3.04-3.32). OFF-Missions last 47.2 min (SD 42.3; CI 46.9-47.4), while ON-Missions are processed after 79.7 min on average (SD 47.6; CI 79.6-79.9). ON-Missions generated a turnover of more than € 114 million, while OFF-Missions made a loss of almost € 13 million. CONCLUSIONS This study particularly highlights the increasing utilization of emergency devices; especially in OFF-Missions, the resources of the EMS have a higher number of operations than PTS. OFF-Missions cause immensely high costs due to misallocations from an economic point of view. Appropriate patient management appears necessary from both medical and economic perspective, which requires multiple solution approaches.
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Affiliation(s)
- Marc S Schehadat
- Institute for Occupational Medicine, Social Medicine and Environmental Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, House 9b, 60590, Frankfurt/Main, Germany.
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany.
| | - Guido Scherer
- District Administration Mainz-Bingen, Department of Civil Protection, Ingelheim/Rhein, Germany
| | - David A Groneberg
- Institute for Occupational Medicine, Social Medicine and Environmental Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, House 9b, 60590, Frankfurt/Main, Germany
| | - Manfred Kaps
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Michael H K Bendels
- Institute for Occupational Medicine, Social Medicine and Environmental Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, House 9b, 60590, Frankfurt/Main, Germany
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Alanazy ARM, Wark S, Fraser J, Nagle A. Nontransported Cases after Emergency Medical Service Callout in the Rural and Urban Areas of the Riyadh Region. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2020; 9:38-44. [PMID: 33519342 PMCID: PMC7839576 DOI: 10.4103/sjmms.sjmms_560_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/13/2020] [Accepted: 11/22/2020] [Indexed: 11/04/2022]
Abstract
Background Callouts resulting in patient nontransportation can impact the overall quality of prehospital Emergency Medical Service (EMS), as resources in health care are finite. While some studies have investigated the causes of nontransportation, few have examined whether there are differences between urban and rural patients. Similarly, there has been limited research focused on rural EMS in locations such as the Middle East. Objectives This study investigated EMS cases that resulted in nontransportation in the urban and rural areas of the Riyadh region in the Kingdom of Saudi Arabia. Methods A cross-sectional study of 800 (400 rural and 400 urban) patient records was undertaken, using 12 months (January 1 to December 31, 2017) of data from the Saudi Red Crescent EMS. A random sampling method was used to select ambulance records from the 78 urban and rural EMS stations in the Riyadh region, with demographic data and reasons for patient nontransport analyzed comparatively. Results A total of 310 cases were nontransported (39%) (rural: 146; urban = 164). The highest rates of nontransportation cases were of medical and trauma callouts (44.6% and 39.6%, respectively), which was consistent in both areas. The most common reason for nontransportation in both urban and rural areas was refusal of treatment and transportation (66.5% and 59.9%, respectively). Further, 10 patients were treated on-scene and released by rural EMS, while no urban patients were treated and released. Overall, the case presentations of nontransported patients did not differ significantly between both areas, and it was found that gender, age, and geographic location were not predictors for nontransportation. Conclusions The high rate of nontransportation, particularly in medical and trauma callouts, indicates that a review of current EMS protocols may be required, along with consideration of relevant community education programs.
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Affiliation(s)
- Ahmed Ramdan M Alanazy
- School of Rural Medicine, Faculty of Medicine and Health, University of New England, Armidale, New South Wales, Australia
| | - Stuart Wark
- School of Rural Medicine, Faculty of Medicine and Health, University of New England, Armidale, New South Wales, Australia
| | - John Fraser
- School of Rural Medicine, Faculty of Medicine and Health, University of New England, Armidale, New South Wales, Australia
| | - Amanda Nagle
- School of Rural Medicine, Faculty of Medicine and Health, University of New England, Armidale, New South Wales, Australia
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12
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Eastwood K, Nambiar D, Dwyer R, Lowthian JA, Cameron P, Smith K. Ambulance dispatch of older patients following primary and secondary telephone triage in metropolitan Melbourne, Australia: a retrospective cohort study. BMJ Open 2020; 10:e042351. [PMID: 33158837 PMCID: PMC7651717 DOI: 10.1136/bmjopen-2020-042351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Most calls to ambulance result in emergency ambulance dispatch (direct dispatch) following primary telephone triage. Ambulance Victoria uses clinician-led secondary telephone triage for patients identified as low-acuity during primary triage to refer them to alternative care pathways; however, some are returned for ambulance dispatch (secondary dispatch). Older adult patients are frequent users of ambulance services; however, little is known about the appropriateness of subsequent secondary dispatches. OBJECTIVES To examine the appropriateness of secondary dispatch through a comparison of the characteristics and ambulance outcomes of older patients dispatched an emergency ambulance via direct or secondary dispatch. DESIGN A retrospective cohort study of ambulance patient data between September 2009 and June 2012 was conducted. SETTING The secondary telephone triage service operated in metropolitan Melbourne, Victoria, Australia during the study period. PARTICIPANTS There were 90 086 patients included aged 65 years and over who had an emergency ambulance dispatch via direct or secondary dispatch with one of the five most common secondary dispatch paramedic diagnoses. MAIN OUTCOME MEASURES Descriptive analyses compared characteristics, treatment and transportation rates between direct and secondary dispatch patients. RESULTS The dispatch groups were similar in demographics, vital signs and hospital transportation rates. However, secondary dispatch patients were half as likely to be treated by paramedics (OR 0.51; CI 0.48 to 0.55; p<0.001). Increasing age was associated with decreasing treatment (p<0.005) and increasing transportation rates (p<0.005). CONCLUSION Secondary triage could identify patients who would ultimately be transported to an emergency department. However, the lower paramedic treatment rates suggest many secondary dispatch patients may have been suitable for referral to alternative low-acuity transport or referral options.
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Affiliation(s)
- Kathryn Eastwood
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
| | - Dhanya Nambiar
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rosamond Dwyer
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Judy A Lowthian
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Bolton Clarke Research Institute, Bolton Clarke, Bentleigh, Victoria, Australia
| | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Karen Smith
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
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13
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Voss S, Brandling J, Pollard K, Taylor H, Black S, Buswell M, Cheston R, Cullum S, Foster T, Kirby K, Prothero L, Purdy S, Solway C, Benger J. A qualitative study on conveyance decision-making during emergency call outs to people with dementia: the HOMEWARD project. BMC Emerg Med 2020; 20:6. [PMID: 31996145 PMCID: PMC6988190 DOI: 10.1186/s12873-020-0306-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 01/21/2020] [Indexed: 12/14/2022] Open
Abstract
Background Paramedics are increasingly required to make complex decisions as to whether they should convey a patient to hospital or manage their condition at the scene. Dementia can be a significant barrier to the assessment process. However, to our knowledge no research has specifically examined the process of decision-making by paramedics in relation to people with dementia. This qualitative study was designed to investigate the factors influencing the decision-making process during Emergency Medical Services (EMS) calls to older people with dementia who did not require immediate clinical treatment. Methods This qualitative study used a combination of observation, interview and document analysis to investigate the factors influencing the decision-making process during EMS calls to older people with dementia. A researcher worked alongside paramedics in the capacity of observer and recruited eligible patients to participate in case studies. Data were collected from observation notes of decision-making during the incident, patient care records and post incident interviews with participants, and analysed thematically. Findings Four main themes emerged from the data concerning the way that paramedics make conveyance decisions when called to people with dementia: 1) Physical condition; the key factor influencing paramedics’ decision-making was the physical condition of the patient. 2) Cognitive capacity; most of the participants preferred not to remove patients with a diagnosis of dementia from surroundings familiar to them, unless they deemed it absolutely essential. 3) Patient circumstances; this included the patient’s medical history and the support available to them. 4) Professional influences; participants also drew on other perspectives, such as advice from colleagues or information from the patient’s General Practitioner, to inform their decision-making. Conclusion The preference for avoiding unnecessary conveyance for patients with dementia, combined with difficulties in obtaining an accurate patient medical history and assessment, mean that decision-making can be particularly problematic for paramedics. Further research is needed to find reliable ways of assessing patients and accessing information to support conveyance decisions for EMS calls to people with dementia.
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Affiliation(s)
- Sarah Voss
- Faculty of Health and Applied Sciences, University of the West of England, Glenside Campus, Blackberry Hill, Bristol, BS16 1DD, UK.
| | - Janet Brandling
- Faculty of Health and Applied Sciences, University of the West of England, Glenside Campus, Blackberry Hill, Bristol, BS16 1DD, UK
| | - Katherine Pollard
- Faculty of Health and Applied Sciences, University of the West of England, Glenside Campus, Blackberry Hill, Bristol, BS16 1DD, UK
| | - Hazel Taylor
- Research Design Service, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Sarah Black
- Research and Audit Department, South Western Ambulance Service NHS Foundation Trust, Taunton, UK
| | - Marina Buswell
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Richard Cheston
- Faculty of Health and Applied Sciences, University of the West of England, Glenside Campus, Blackberry Hill, Bristol, BS16 1DD, UK
| | - Sarah Cullum
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Theresa Foster
- Research Support Services, East of England Ambulance Service NHS Trust, Bury St. Edmunds, UK
| | - Kim Kirby
- Faculty of Health and Applied Sciences, University of the West of England, Glenside Campus, Blackberry Hill, Bristol, BS16 1DD, UK.,Research and Audit Department, South Western Ambulance Service NHS Foundation Trust, Taunton, UK
| | - Larissa Prothero
- Research Support Services, East of England Ambulance Service NHS Trust, Bury St. Edmunds, UK
| | - Sarah Purdy
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Chris Solway
- Research Network, Alzheimer's Society, London, UK
| | - Jonathan Benger
- Faculty of Health and Applied Sciences, University of the West of England, Glenside Campus, Blackberry Hill, Bristol, BS16 1DD, UK
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14
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Noble AJ, Mathieson A, Ridsdale L, Holmes EA, Morgan M, McKinlay A, Dickson JM, Jackson M, Hughes DA, Goodacre S, Marson AG. Developing patient-centred, feasible alternative care for adult emergency department users with epilepsy: protocol for the mixed-methods observational 'Collaborate' project. BMJ Open 2019; 9:e031696. [PMID: 31678950 PMCID: PMC6830638 DOI: 10.1136/bmjopen-2019-031696] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Emergency department (ED) visits for epilepsy are common, costly, often clinically unnecessary and typically lead to little benefit for epilepsy management. An 'Alternative Care Pathway' (ACP) for epilepsy, which diverts people with epilepsy (PWE) away from ED when '999' is called and leads to care elsewhere, might generate savings and facilitate improved ambulatory care. It is unknown though what features it should incorporate to make it acceptable to persons from this particularly vulnerable target population. It also needs to be National Health Service (NHS) feasible. This project seeks to identify the optimal ACP configuration. METHODS AND ANALYSIS Mixed-methods project comprising three-linked stages. In Stage 1, NHS bodies will be surveyed on ACPs they are considering and semi-structured interviews with PWE and their carers will explore attributes of care important to them and their concerns and expectations regarding ACPs. In Stage 2, Discrete Choice Experiments (DCE) will be completed with PWE and carers to identify the relative importance placed on different care attributes under common seizure scenarios and the trade-offs people are willing to make. The uptake of different ACP configurations will be estimated. In Stage 3, two Knowledge Exchange workshops using a nominal group technique will be run. NHS managers, health professionals, commissioners and patient and carer representatives will discuss DCE results and form a consensus on which ACP configuration best meets users' needs and is NHS feasible. ETHICS AND DISSEMINATION Ethical approval: NRES Committee (19/WM/0012) and King's College London ethics Committee (LRS-18/19-10353). Primary output will be identification of optimal ACP configuration which should be prioritised for implementation and evaluation. A pro-active dissemination strategy will make those considering developing or supporting an epilepsy ACP aware of the project and opportunities to take part in it. It will also ensure they are informed of its findings. PROJECT REGISTRATION NUMBER Researchregistry4723.
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Affiliation(s)
- Adam J Noble
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Amy Mathieson
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Leone Ridsdale
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - E A Holmes
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Alison McKinlay
- Basic & Clinical Neuroscience, King's College London, London, UK
| | - Jon Mark Dickson
- Academic Unit of Primary Medical Care, The University of Sheffield, Sheffield, UK
| | - Mike Jackson
- North West Ambulance Service NHS Trust, Bolton, UK
| | - Dyfrig A Hughes
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Steve Goodacre
- Medical Care Research Unit, University of Sheffield, Sheffield, UK
| | - Anthony G Marson
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
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15
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Hagiwara MA, Magnusson C, Herlitz J, Seffel E, Axelsson C, Munters M, Strömsöe A, Nilsson L. Adverse events in prehospital emergency care: a trigger tool study. BMC Emerg Med 2019; 19:14. [PMID: 30678636 PMCID: PMC6345067 DOI: 10.1186/s12873-019-0228-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 01/15/2019] [Indexed: 11/30/2022] Open
Abstract
Background Prehospital emergency care has developed rapidly during the past decades. The care is given in a complex context which makes prehospital care a potential high-risk activity when it comes to patient safety. Patient safety in the prehospital setting has been only sparsely investigated. The aims of the present study were 1) To investigate the incidence of adverse events (AEs) in prehospital care and 2) To investigate the factors contributing to AEs in prehospital care. Methods We used a retrospective study design where 30 randomly selected prehospital medical records were screened for AEs each month in three prehospital organizations in Sweden during a period of one year. A total of 1080 prehospital medical records were included. The record review was based on the use of 11 screening criteria. Results The reviewers identified 46 AEs in 46 of 1080 (4.3%) prehospital medical records. Of the 46 AEs, 43 were classified as potential for harm (AE1) (4.0, 95% CI = 2.9–5.4) and three as harm identified (AE2) (0.3, 95% CI = 0.1–0.9). However, among patients with a life-threatening condition (priority 1), the risk of AE was higher (16.5%). The most common factors contributing to AEs were deviations from standard of care and missing, incomplete, or unclear documentation. The most common cause of AEs was the result of action(s) or inaction(s) by the emergency medical service (EMS) crew. Conclusions There were 4.3 AEs per 100 ambulance missions in Swedish prehospital care. The majority of AEs originated from deviations from standard of care and incomplete documentation. There was an increase in the risk of AE among patients who the EMS team assessed as having a life-threatening condition. Most AEs were possible to avoid. Electronic supplementary material The online version of this article (10.1186/s12873-019-0228-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Magnus Andersson Hagiwara
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden.
| | - Carl Magnusson
- Department of Molecular and Clinical Medicine, University of Gothenburg and Sahlgrenska University Hospital, SE-405 30, Gothenburg, Sweden
| | - Johan Herlitz
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Elin Seffel
- Department of Ambulance Care, Södra Älvsborg Hospital (SÄS), SE-501 82, Borås, Sweden
| | - Christer Axelsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Monica Munters
- Department of Ambulance Care, Region of Dalarna, SE-791 29, Falun, Sweden
| | - Anneli Strömsöe
- School of Health, Care and Social Welfare, Mälardalens högskola, SE-721 23, Västerås, Sweden
| | - Lena Nilsson
- Department of Anaesthesiology and Intensive Care and Department of Medical and Health Sciences, Linköping University, SE-581 85, Linköping, Sweden
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16
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Ebben RHA, Castelijns M, Frenken J, Vloet LCM. Characteristics of non-conveyance ambulance runs: A retrospective study in the Netherlands. World J Emerg Med 2019; 10:239-243. [PMID: 31534599 DOI: 10.5847/wjem.j.1920-8642.2019.04.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Remco H A Ebben
- HAN University of Applied Sciences, Faculty of Health and Social Studies, Research Department of Emergency and Critical Care, Nijmegen, the Netherlands
| | | | - Joost Frenken
- Ambulance Service Brabant Zuid Oost, Eindhoven, the Netherlands
| | - Lilian C M Vloet
- HAN University of Applied Sciences, Faculty of Health and Social Studies, Research Department of Emergency and Critical Care, Nijmegen, the Netherlands.,Radboud University Medical Center, Nijmegen, the Netherlands
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17
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Breeman W, Poublon NA, Verhofstad MHJ, Van Lieshout EMM. Safety of on-scene medical care by EMS nurses in non-transported patients: a prospective, observational study. Scand J Trauma Resusc Emerg Med 2018; 26:79. [PMID: 30217231 PMCID: PMC6137918 DOI: 10.1186/s13049-018-0540-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 08/29/2018] [Indexed: 11/17/2022] Open
Abstract
Background After on-scene examination and /or treatment, emergency medical services (EMS) nurses must decide whether the patient requires further assessment or treatment, most frequently in a hospital. The primary objective of this study was to assess the reliability of the current EMS protocol by determining whether the decision not to transport the patient to a care provider was correct or not. Methods Adults receiving on-scene medical care by an EMS rapid responder or full team without transport to the hospital were included in this prospective observational study. The primary outcome measure was secondary consultation within 24 h after an on-scene EMS evaluation without transport for the same or a closely related complaint. The secondary outcome measures were patient satisfaction, type of secondarily consulted health care provider, provisional and definitive diagnosis, and correctness of the EMS members’ decision to provide on-scene medical care without transport. Results Of the 1095 participating patients, 271 (24.7%) patients requested secondary medical attention for the same complaint. This percentage was significantly larger in incidents attended by an ambulance team than by a rapid responder (N = 248 (26.5%) vs. N = 23 (14.4%); p < 0.05). In eleven (1.0%) cases an urgent medical diagnosis requiring admission was missed. A total of 873 (79.7%) patients were satisfied with the decision not to be transported. In 44 (4.0%) cases the EMS nurse’s decision was rated incorrect since the patient needed help contradictory to the EMS nurse’s recommendation. Conclusions The data show that EMS nurses can effectively examine patients, but a low threshold of referral for consultation should be considered because one in four patients requested secondary medical attention for the same complaint(s) again. However, due to a low response rate (11.3%) more research is needed to further determine the safety of the current EMS protocol. Trial registration Not applicable.
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Affiliation(s)
- Wim Breeman
- AmbulanceZorg Rotterdam-Rijnmond, P.O. Box 4, 2990 AA, Barendrecht, The Netherlands.,Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Nathan A Poublon
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Michael H J Verhofstad
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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18
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O’Cathain A, Knowles E, Bishop-Edwards L, Coster J, Crum A, Jacques R, James C, Lawson R, Marsh M, O’Hara R, Siriwardena AN, Stone T, Turner J, Williams J. Understanding variation in ambulance service non-conveyance rates: a mixed methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06190] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
In England in 2015/16, ambulance services responded to nearly 11 million calls. Ambulance Quality Indicators show that half of the patients receiving a response by telephone or face to face were not conveyed to an emergency department. A total of 11% of patients received telephone advice only. A total of 38% of patients were sent an ambulance but were not conveyed to an emergency department. For the 10 large ambulance services in England, rates of calls ending in telephone advice varied between 5% and 17%. Rates of patients who were sent an ambulance but not conveyed to an emergency department varied between 23% and 51%. Overall non-conveyance rates varied between 40% and 68%.
Objective
To explain variation in non-conveyance rates between ambulance services.
Design
A sequential mixed methods study with five work packages.
Setting
Ten of the 11 ambulance services serving > 99% of the population of England.
Methods
(1) A qualitative interview study of managers and paramedics from each ambulance service, as well as ambulance commissioners (totalling 49 interviews undertaken in 2015). (2) An analysis of 1 month of routine data from each ambulance service (November 2014). (3) A qualitative study in three ambulance services with different published rates of calls ending in telephone advice (120 hours of observation and 20 interviews undertaken in 2016). (4) An analysis of routine data from one ambulance service linked to emergency department attendance, hospital admission and mortality data (6 months of 2013). (5) A substudy of non-conveyance for people calling 999 with breathing problems.
Results
Interviewees in the qualitative study identified factors that they perceived to affect non-conveyance rates. Where possible, these perceptions were tested using routine data. Some variation in non-conveyance rates between ambulance services was likely to be due to differences in the way rates were calculated by individual services, particularly in relation to telephone advice. Rates for the number of patients sent an ambulance but not conveyed to an emergency department were associated with patient-level factors: age, sex, deprivation, time of call, reason for call, urgency level and skill level of attending crew. However, variation between ambulance services remained after adjustment for patient-level factors. Variation was explained by ambulance service-level factors after adjustment for patient-level factors: the percentage of calls attended by advanced paramedics [odds ratio 1.05, 95% confidence interval (CI) 1.04 to 1.07], the perception of ambulance service staff and commissioners that advanced paramedics were established and valued within the workforce of an ambulance service (odds ratio 1.84, 95% CI 1.45 to 2.33), and the perception of ambulance service staff and commissioners that senior management was risk averse regarding non-conveyance within an ambulance service (odds ratio 0.78, 95% CI 0.63 to 0.98).
Limitations
Routine data from ambulance services are complex and not consistently collected or analysed by ambulance services, thus limiting the utility of comparative analyses.
Conclusions
Variation in non-conveyance rates between ambulance services in England could be reduced by addressing variation in the types of paramedics attending calls, variation in how advanced paramedics are used and variation in perceptions of the risk associated with non-conveyance within ambulance service management. Linking routine ambulance data with emergency department attendance, hospital admission and mortality data for all ambulance services in the UK would allow comparison of the safety and appropriateness of their different non-conveyance rates.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Alicia O’Cathain
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Emma Knowles
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Joanne Coster
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Annabel Crum
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Richard Jacques
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Cathryn James
- Yorkshire Ambulance Service NHS Trust, Wakefield, UK
- Association of Ambulance Chief Executives, London, UK
| | - Rod Lawson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Medical Humanities Sheffield, University of Sheffield, Sheffield, UK
| | | | - Rachel O’Hara
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Tony Stone
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Janette Turner
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Julia Williams
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
- South East Coast Ambulance Service NHS Foundation Trust, Crawley, UK
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19
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Pekanoja S, Hoikka M, Kyngäs H, Elo S. Non-transport emergency medical service missions - a retrospective study based on medical charts. Acta Anaesthesiol Scand 2018; 62:701-708. [PMID: 29363100 DOI: 10.1111/aas.13071] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 12/16/2017] [Accepted: 12/27/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND In Finland, approximately 40% of emergency medical service (EMS) missions do not result in transport of the patient to a hospital by ambulance, and there is wide variability in the reasons underlying non-transport decisions. The aim of this study was to describe the context of these EMS non-transport missions. METHODS The data were collected retrospectively between 3 September and 20 October 2014 by investigating non-transport EMS charts (n = 1154). Event information and patients' main symptoms were extracted from information found in EMS charts and quantified using content and statistical analyses. RESULTS Patients' need for EMS were explained by various reasons. One-third of the missions were caused by organ-specific symptoms, whereas in 30.8% of cases the reason for EMS was unspecified. Sudden onset symptoms were noted for 38.4% of the cases, whereas in 14.7% of cases the symptoms had persisted for days or weeks before EMS contact. EMS personnel offered guidance instead of treatment in 79.2% of the missions. CONCLUSIONS Non-transport missions represent a significant daily work load for the EMS. Although most of the symptoms showed acute onset, the majority of these missions involved only assessment of medical necessity and/or guidance without any medical treatment. It is questionable whether this use of the EMS is cost-effective for any healthcare system.
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Affiliation(s)
- S. Pekanoja
- Research Unit of Nursing Science and Health Management; University of Oulu; Oulu Finland
| | - M. Hoikka
- Division of Intensive Care; Department of Anaesthesiology; Medical Research Centre; Research Unit of Surgery, Anaesthesia and Intensive Care; Oulu University Hospital; University of Oulu; Oulu Finland
| | - H. Kyngäs
- Research Unit of Nursing Science and Health Management; Medical Research Centre; Oulu University Hospital; University of Oulu; Oulu Finland
| | - S. Elo
- Research Unit of Nursing Science and Health Management; Medical Research Centre; Oulu University Hospital; University of Oulu; Oulu Finland
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20
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Remote clinical decision making: Evaluation of a new education module. Nurse Educ Pract 2018; 29:150-158. [PMID: 29367126 DOI: 10.1016/j.nepr.2018.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 11/10/2017] [Accepted: 01/02/2018] [Indexed: 11/22/2022]
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21
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A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review. Scand J Trauma Resusc Emerg Med 2017; 25:71. [PMID: 28716132 PMCID: PMC5513207 DOI: 10.1186/s13049-017-0409-6] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 06/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This 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. METHODS We 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. RESULTS We 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). CONCLUSIONS Non-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.
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Leggatt L, Van Aarsen K, Columbus M, Dukelow A, Lewell M, Davis M, McLeod S. Morbidity and Mortality Associated with Prehospital “Lift-assist” Calls. PREHOSP EMERG CARE 2017; 21:556-562. [DOI: 10.1080/10903127.2017.1308607] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Early prehospital assessment of non-urgent patients and outcomes at the appropriate level of care: A prospective exploratory study. Int Emerg Nurs 2017; 32:45-49. [PMID: 28291697 DOI: 10.1016/j.ienj.2017.02.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 02/08/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The Ambulance Organization of Sweden provides qualified medical assessment and treatment by ambulance nurses based on patient needs regarding appropriate levels of care. A new model for patients with non-urgent medical conditions has been introduced. The main objective of this study was to examine early prehospital assessment of non-urgent patients, and its impact on the choice of the appropriate level of care. METHODS The study design was a 1-year, prospective study, involving an ambulance district in southwestern Sweden with a population of 78,000. Eligible patients were from18years of age, assessed as priority GREEN by Rapid Emergency Triage and Treatment System (RETTS). Ambulance nurses contacted primary care physicians on decisions on whether a patient should be transported to a primary healthcare unit or an A&E. Data was collected from electronic health records from April 2014 to July 2015. A comparison was made with a retrospective control group without consulting a physician concerning the appropriate level of care. RESULTS 394 patients were included, 184 in the intervention group, and 210 in the control group. There were statistically significant differences in favor of the study group (p<0.001) regarding no transport, or transport and admission to an A&E. The groups did not differ significantly regarding transport to a primary care unit. CONCLUSION This prehospital assessment model indicates a decrease in ambulance transports to an A&E and admissions to a hospital ward. Collaboration between ambulance nurses and primary physicians affects the decision for the appropriate level of care for patients with a non-urgent condition.
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Snooks HA, Anthony R, Chatters R, Dale J, Fothergill R, Gaze S, Halter M, Humphreys I, Koniotou M, Logan P, Lyons R, Mason S, Nicholl J, Peconi J, Phillips C, Phillips J, Porter A, Siriwardena AN, Smith G, Toghill A, Wani M, Watkins A, Whitfield R, Wilson L, Russell IT. Support and Assessment for Fall Emergency Referrals (SAFER) 2: a cluster randomised trial and systematic review of clinical effectiveness and cost-effectiveness of new protocols for emergency ambulance paramedics to assess older people following a fall with referral to community-based care when appropriate. Health Technol Assess 2017; 21:1-218. [PMID: 28397649 PMCID: PMC5402213 DOI: 10.3310/hta21130] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Emergency calls are frequently made to ambulance services for older people who have fallen, but ambulance crews often leave patients at the scene without any ongoing care. We evaluated a new clinical protocol which allowed paramedics to assess older people who had fallen and, if appropriate, refer them to community-based falls services. OBJECTIVES To compare outcomes, processes and costs of care between intervention and control groups; and to understand factors which facilitate or hinder use. DESIGN Cluster randomised controlled trial. PARTICIPANTS Participating paramedics at three ambulance services in England and Wales were based at stations randomised to intervention or control arms. Participants were aged 65 years and over, attended by a study paramedic for a fall-related emergency service call, and resident in the trial catchment areas. INTERVENTIONS Intervention paramedics received a clinical protocol with referral pathway, training and support to change practice. Control paramedics continued practice as normal. OUTCOMES The primary outcome comprised subsequent emergency health-care contacts (emergency admissions, emergency department attendances, emergency service calls) or death at 1 month and 6 months. Secondary outcomes included pathway of care, ambulance service operational indicators, self-reported outcomes and costs of care. Those assessing outcomes remained blinded to group allocation. RESULTS Across sites, 3073 eligible patients attended by 105 paramedics from 14 ambulance stations were randomly allocated to the intervention group, and 2841 eligible patients attended by 110 paramedics from 11 stations were randomly allocated to the control group. After excluding dissenting and unmatched patients, 2391 intervention group patients and 2264 control group patients were included in primary outcome analyses. We did not find an effect on our overall primary outcome at 1 month or 6 months. However, further emergency service calls were reduced at both 1 month and 6 months; a smaller proportion of patients had made further emergency service calls at 1 month (18.5% vs. 21.8%) and the rate per patient-day at risk at 6 months was lower in the intervention group (0.013 vs. 0.017). Rate of conveyance to emergency department at index incident was similar between groups. Eight per cent of trial eligible patients in the intervention arm were referred to falls services by attending paramedics, compared with 1% in the control arm. The proportion of patients left at scene without further care was lower in the intervention group than in the control group (22.6% vs. 30.3%). We found no differences in duration of episode of care or job cycle. No adverse events were reported. Mean cost of the intervention was £17.30 per patient. There were no significant differences in mean resource utilisation, utilities at 1 month or 6 months or quality-adjusted life-years. In total, 58 patients, 25 paramedics and 31 stakeholders participated in focus groups or interviews. Patients were very satisfied with assessments carried out by paramedics. Paramedics reported that the intervention had increased their confidence to leave patients at home, but barriers to referral included patients' social situations and autonomy. CONCLUSIONS Findings indicate that this new pathway may be introduced by ambulance services at modest cost, without risk of harm and with some reductions in further emergency calls. However, we did not find evidence of improved health outcomes or reductions in overall NHS emergency workload. Further research is necessary to understand issues in implementation, the costs and benefits of e-trials and the performance of the modified Falls Efficacy Scale. TRIAL REGISTRATION Current Controlled Trials ISRCTN60481756 and PROSPERO CRD42013006418. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 13. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Helen A Snooks
- Patient and Population Health and Informatics, Swansea University Medical School, Swansea, UK
| | - Rebecca Anthony
- Patient and Population Health and Informatics, Swansea University Medical School, Swansea, UK
| | - Robin Chatters
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachael Fothergill
- Clinical Audit and Research Unit, London Ambulance Service NHS Trust, London, UK
| | - Sarah Gaze
- Patient and Population Health and Informatics, Swansea University Medical School, Swansea, UK
| | - Mary Halter
- Faculty of Health and Social Care Sciences, St George's University Hospital, London, UK
| | - Ioan Humphreys
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Marina Koniotou
- Patient and Population Health and Informatics, Swansea University Medical School, Swansea, UK
| | - Phillipa Logan
- Community Health Sciences, University of Nottingham, Nottingham, UK
| | - Ronan Lyons
- Patient and Population Health and Informatics, Swansea University Medical School, Swansea, UK
| | - Suzanne Mason
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jon Nicholl
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Julie Peconi
- Patient and Population Health and Informatics, Swansea University Medical School, Swansea, UK
| | - Ceri Phillips
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Judith Phillips
- Centre for Innovative Ageing, Swansea University, Swansea, UK
| | - Alison Porter
- Patient and Population Health and Informatics, Swansea University Medical School, Swansea, UK
| | | | | | | | - Mushtaq Wani
- Department of Geriatric and Stroke Medicine, Morriston Hospital, Swansea, UK
| | - Alan Watkins
- Patient and Population Health and Informatics, Swansea University Medical School, Swansea, UK
| | - Richard Whitfield
- Pre-hospital Emergency Research Unit (PERU), Welsh Ambulance Services NHS Trust, Cardiff, UK
| | - Lynsey Wilson
- Patient and Population Health and Informatics, Swansea University Medical School, Swansea, UK
| | - Ian T Russell
- Patient and Population Health and Informatics, Swansea University Medical School, Swansea, UK
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Paramedics assessing Elders at Risk for Independence Loss (PERIL): Derivation, Reliability and Comparative Effectiveness of a Clinical Prediction Rule. CAN J EMERG MED 2017; 18:121-32. [PMID: 26988720 DOI: 10.1017/cem.2016.14] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We conducted a program of research to derive and test the reliability of a clinical prediction rule to identify high-risk older adults using paramedics' observations. METHODS We developed the Paramedics assessing Elders at Risk of Independence Loss (PERIL) checklist of 43 yes or no questions, including the Identifying Seniors at Risk (ISAR) tool items. We trained 1,185 paramedics from three Ontario services to use this checklist, and assessed inter-observer reliability in a convenience sample. The primary outcome, return to the ED, hospitalization, or death within one month was assessed using provincial databases. We derived a prediction rule using multivariable logistic regression. RESULTS We enrolled 1,065 subjects, of which 764 (71.7%) had complete data. Inter-observer reliability was good or excellent for 40/43 questions. We derived a four-item rule: 1) "Problems in the home contributing to adverse outcomes?" (OR 1.43); 2) "Called 911 in the last 30 days?" (OR 1.72); 3) male (OR 1.38) and 4) lacks social support (OR 1.4). The PERIL rule performed better than a proxy measure of clinical judgment (AUC 0.62 vs. 0.56, p=0.02) and adherence was better for PERIL than for ISAR. CONCLUSIONS The four-item PERIL rule has good inter-observer reliability and adherence, and had advantages compared to a proxy measure of clinical judgment. The ISAR is an acceptable alternative, but adherence may be lower. If future research validates the PERIL rule, it could be used by emergency physicians and paramedic services to target preventative interventions for seniors identified as high-risk.
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Porter A, Snooks H, Youren A, Gaze S, Whitfield R, Rapport F, Woollard M. Should I stay or should I go?’ Deciding whether to go to hospital after a 999 call. J Health Serv Res Policy 2016; 12 Suppl 1:S1-32-8. [PMID: 17411505 DOI: 10.1258/135581907780318392] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective In most UK ambulance services, crews attending someone who has phoned the emergency services on ‘999’ will take the patient to hospital, unless the patient makes the decision to stay at home (or wherever they happen to be when the ambulance arrives). Safety concerns have been raised about non-conveyance decisions. Weunder took a study of one UK Ambulance Service to examine ambulance crew members’ views on how decision-making about non-conveyance works in practice in relation to non-urgent calls. Methods A total of 25 paramedics took part in three focus groups. Focus groups were transcribed and analysed thematically. Results The ambulance service's apparently straight forward guidance on decision-making about non-conveyance proved tricky in the messiness of the real world, for two reasons. The first was to do with the notion of the patient's capacity to make decisions and how this was interpreted. The second was to do with the complexity of the decision-making process, in which the patient, the crew and, in many cases, family or carers often take part in negotiation and de facto joint decision-making. Conclusions There is a mismatch between policy and practice in relation to non-conveyance decisions. Findings should be built into research and service development in this rapidly changing field of practice in emergency and/or unscheduled care. The commonly accepted perspective on shared decision-making should be extended to include the context of ‘999’ ambulance calls.
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Affiliation(s)
- Alison Porter
- Centre for Health Information, Research & Evaluation, School of Medicine, Swansea University, Swansea SA2 8PP, UK.
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The unseen cost of falls: The environmental impact of attending falls call out by the emergency ambulance services. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2015.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Morita T, Tsubokura M, Furutani T, Nomura S, Ochi S, Leppold C, Takahara K, Shimada Y, Fujioka S, Kami M, Kato S, Oikawa T. Impacts of the 2011 Fukushima nuclear accident on emergency medical service times in Soma District, Japan: a retrospective observational study. BMJ Open 2016; 6:e013205. [PMID: 27683521 PMCID: PMC5051455 DOI: 10.1136/bmjopen-2016-013205] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess the influence of the 3.11 triple disaster (earthquake, tsunami and nuclear accident) on the emergency medical service (EMS) system in Fukushima. METHODS Total EMS time (from EMS call to arrival at a hospital) was assessed in the EMS system of Soma district, located 10-40 km north of the nuclear plant, from 11 March to 31 December 2011. We defined the affected period as when total EMS time was significantly extended after the disasters compared with the historical control data from 1 January 2009 to 10 March 2011. To identify risk factors associated with the extension of total EMS time after the disasters, we investigated trends in 3 time segments of total EMS time; response time, defined as time from an EMS call to arrival at the location, on-scene time, defined as time from arrival at the location to departure, and transport time, defined as time from departure from the location to arrival at a hospital. RESULTS For the affected period from week 0 to week 11, the median total EMS time was 36 (IQR 27-52) minutes, while that in the predisaster control period was 31 (IQR 24-40) min. The percentage of transports exceeding 60 min in total EMS time increased from 8.2% (584/7087) in the control period to 22.2% (151/679) in the affected period. Among the 3 time segments, there was the most change in transport time (standardised mean difference: 0.41 vs 0.13-0.17). CONCLUSIONS EMS transport was significantly delayed for ∼3 months, from week 1 to 11 after the 3.11 triple disaster. This delay may be attributed to malfunctioning emergency hospitals after the triple disaster.
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Affiliation(s)
- Tomohiro Morita
- Department of Internal Medicine, Soma Central Hospital, Soma City, Fukushima, Japan
- Division of Social Communication System for Advanced Clinical Research, Institute of Medical Science, The University of Tokyo, Minato-ku, Tokyo, Japan
| | - Masaharu Tsubokura
- Division of Social Communication System for Advanced Clinical Research, Institute of Medical Science, The University of Tokyo, Minato-ku, Tokyo, Japan
| | - Tomoyuki Furutani
- Faculty of Policy Management, Keio University, Fujisawa, Kanagawa, Japan
| | - Shuhei Nomura
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Sae Ochi
- Department of Internal Medicine, Soma Central Hospital, Soma City, Fukushima, Japan
| | - Claire Leppold
- Department of Research, Minamisoma Municipal General Hospital, Minamisoma City, Fukushima, Japan
| | - Kazuhiro Takahara
- Fire Suppression Division, the Soma Regional Fire Department, Minamisoma City, Fukushima, Japan
| | - Yuki Shimada
- Department of Neurosurgery, Minamisoma Municipal General Hospital, Minamisoma City, Fukushima, Japan
| | - Sho Fujioka
- Department of Gastroenterology, Minamisoma Municipal General Hospital, Minamisoma City, Fukushima, Japan
| | - Masahiro Kami
- Division of Social Communication System for Advanced Clinical Research, Institute of Medical Science, The University of Tokyo, Minato-ku, Tokyo, Japan
| | - Shigeaki Kato
- Department of Radiation Protection, Soma Central Hospital, Soma City, Fukushima, Japan
| | - Tomoyoshi Oikawa
- Department of Neurosurgery, Minamisoma Municipal General Hospital, Minamisoma City, Fukushima, Japan
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Nehme Z, Andrew E, Smith K. Factors Influencing the Timeliness of Emergency Medical Service Response to Time Critical Emergencies. PREHOSP EMERG CARE 2016; 20:783-791. [PMID: 27487018 DOI: 10.3109/10903127.2016.1164776] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE While emergency medical service (EMS) response times (ERT) remain a leading measure of system performance in many developed countries, relatively few studies have explored the factors associated with meeting benchmark performance for potentially time critical incidents. The purpose of this study was to identify system-level and patient-level factors associated with ERT, which are readily available at the time of ambulance dispatch. METHODS Between July 2009 and June 2014, we included data from 1,000,458 EMS responses to time critical "lights and sirens" incidents in Melbourne, Australia. The primary outcome measure was ERT, defined as the time from emergency call to the arrival of the first EMS team on scene. Quantile regression models were used to identify system-level and patient-level factors associated with 10-percentile intervals of ERT. RESULTS The median ERT was 10.6 minutes (IQR: 8.1-14.0), increasing from 9.6 minutes (IQR: 7.6-12.5) in 2009/10 to 11.0 minutes (IQR: 8.4-14.7) in 2013/14 (p < 0.001). System-level factors independently associated with the 90th percentile ERT were distance to scene, activation time, turnout time, case upgrade, hour of day, day of week, workload in the previous hour, ambulance skill set, priority zero case (e.g., suspected cardiac or respiratory arrest), and average hospital delay time in the previous hour. Patient-level factors such as age, gender, chief medical complaint, and severity of complaint were also significantly associated with ERT. CONCLUSIONS System-level and patient-level factors available at the time of ambulance dispatch are useful predictors of ERT performance, which could be used to improve the timeliness of EMS response.
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Dejean D, Giacomini M, Welsford M, Schwartz L, Decicca P. Inappropriate Ambulance Use: A Qualitative Study of Paramedics' Views. Healthc Policy 2016; 11:67-79. [PMID: 27027794 PMCID: PMC4817967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Existing studies of inappropriate ambulance use focus on its extent, employing clinical criteria. Little is known about how front-line paramedics assess appropriateness. This study investigates how paramedics view and judge appropriate versus inappropriate ambulance use. METHODS We conducted interviews with 19 paramedics working in two regions in southwestern Ontario that were analyzed using grounded theory methods. FINDINGS While blatantly "inappropriate" use is extraordinary, "misuse" is more common, and paramedics determine misuse largely by interpreting patients' abilities to cope with their situations. Paramedics assess this using multiple patient attributes: patient's age, knowledge of the system, system failures, social support available, presence of transportation alternatives, patient's ability to walk and trial of treatment with home remedies. CONCLUSION In the future, paramedic-informed, contextual and non-clinical criteria might supplement clinically based criteria for emergency service-use evaluation and may inform more patient-centred policy interventions to reduce ambulance misuse and inappropriate use.
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Affiliation(s)
- Deirdre Dejean
- Postdoctoral Fellow, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON
| | - Mita Giacomini
- Professor, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON
| | - Michelle Welsford
- Associate Professor, Division of Emergency Medicine, McMaster University, Hamilton, ON
| | - Lisa Schwartz
- Professor, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON
| | - Philip Decicca
- Associate Professor, Department of Economics, McMaster University, Hamilton, ON
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Eastwood K, Morgans A, Smith K, Hodgkinson A, Becker G, Stoelwinder J. A novel approach for managing the growing demand for ambulance services by low-acuity patients. AUST HEALTH REV 2016; 40:378-384. [DOI: 10.1071/ah15134] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 09/29/2015] [Indexed: 11/23/2022]
Abstract
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, 107148 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.
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Cantwell K, Burgess S, Morgans A, Smith K, Livingston M, Dietze P. Temporal trends in falls cases seen by EMS in Melbourne: The effect of residence on time of day and day of week patterns. Injury 2016; 47:266-71. [PMID: 26626807 DOI: 10.1016/j.injury.2015.10.073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 10/23/2015] [Accepted: 10/28/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Injury due to falls is a major public health problem, especially for older people. We aimed to determine the accuracy of the ambulance call taker triage algorithm relative to paramedic assessment, and characterise variation in ambulance service demand for falls cases involving older adults over time and by residence type. METHOD We obtained all ambulance case records for January 2008 to December 2011 for adults aged 65 or over in Melbourne, Australia. Data elements comprised age, gender, date and time of emergency call, dispatch category, location of incident and the patient's clinical condition as ascertained by paramedics. We compared cases coded as falls by the call taker triage algorithm with those identified by paramedics. We also examined temporal variation (hour of day and day of week) in ambulance service demand for cases involving older adults, and compared community-dwelling cases and those from Residential Aged Care Facilities (RACFs). We used negative binomial regression to compare counts and trigonometric regression to compare temporal variation patterns. RESULTS Over the four-year study period 77,891 falls cases involved older adults (6.5% of overall ambulance demand). Eighty-seven per cent of paramedic-assessed falls cases were correctly identified by the triage system. The RACF population was older (median age 87 years, IQR 82-91 vs. 82 years, IQR 76-87), had higher hospital transport rates (89.5% vs. 75.8%) and a higher incidence of falls at any age than the community-dwelling population. The temporal pattern for fall cases for all residence types peaked between 6:00 and 12:00, but fall cases from RACFs showed an additional peak in the evening between 17:00 and 20:00. CONCLUSION Falls by older people are the second-biggest contributor to ambulance demand in Melbourne, consuming significant operational resources. Using call taker triage data instead of paramedic case records to calculate falls cases may underestimate the true incidence of falls by up to 13%. Temporal patterns can inform ambulance service policy and practice, falls referral and prevention programmes to optimise service delivery which will lessen the number of future falls cases.
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Affiliation(s)
- Kate Cantwell
- Centre for Population Health, Burnet Institute, Victoria, Australia; Ambulance Victoria, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria Australia.
| | - Stephen Burgess
- Ambulance Victoria, Victoria, Australia; Benetas, Victoria, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia; Geriatric Medicine Aged Care Research Centre, Eastern Health, Victoria, Australia
| | - Amee Morgans
- Health Ageing Research Unit, Monash University, Victoria Australia; Royal District Nursing Service, Victoria Australia
| | - Karen Smith
- Ambulance Victoria, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria Australia; Emergency Medicine Department, University of Western Australia, Western Australia, Australia
| | - Michael Livingston
- Drug Policy Modelling Program, National Drug and Alcohol Research Centre, University of New South Wales, Australia; Centre for Alcohol Policy Research, La Trobe University, Victoria, Australia
| | - Paul Dietze
- Centre for Population Health, Burnet Institute, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria Australia
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Norman C, Mello M, Choi B. Identifying Frequent Users of an Urban Emergency Medical Service Using Descriptive Statistics and Regression Analyses. West J Emerg Med 2016; 17:39-45. [PMID: 26823929 PMCID: PMC4729417 DOI: 10.5811/westjem.2015.10.28508] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 10/13/2015] [Accepted: 11/01/2015] [Indexed: 11/16/2022] Open
Abstract
This retrospective cohort study provides a descriptive analysis of a population that frequently uses an urban emergency medical service (EMS) and identifies factors that contribute to use among all frequent users. For purposes of this study we divided frequent users into the following groups: low- frequent users (4 EMS transports in 2012), medium-frequent users (5 to 6 EMS transports in 2012), high-frequent users (7 to 10 EMS transports in 2012) and super-frequent users (11 or more EMS transports in 2012). Overall, we identified 539 individuals as frequent users. For all groups of EMS frequent users (i.e. low, medium, high and super) one or more hospital admissions, receiving a referral for follow-up care upon discharge, and having no insurance were found to be statistically significant with frequent EMS use (P<0.05). Within the diagnostic categories, 41.61% of super-frequent users had a diagnosis of "primarily substance abuse/misuse" and among low-frequent users a majority, 53.33%, were identified as having a "reoccurring (medical) diagnosis." Lastly, relative risk ratios for the highest group of users, super-frequent users, were 3.34 (95% CI [1.90-5.87]) for obtaining at least one referral for follow-up care, 13.67 (95% CI [5.60-33.34]) for having four or more hospital admissions and 5.95 (95% CI [1.80-19.63]) for having a diagnoses of primarily substance abuse/misuse. Findings from this study demonstrate that among low- and medium-frequent users a majority of patients are using EMS for reoccurring medical conditions. This could potentially be avoided with better care management. In addition, this study adds to the current literature that illustrates a strong correlation between substance abuse/misuse and high/super-frequent EMS use. For the subgroup analysis among individuals 65 years of age and older, we did not find any of the independent variables included in our model to be statistically significant with frequent EMS use.
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Affiliation(s)
- Chenelle Norman
- Brown University, School of Public Health, Providence, Rhode Island
| | - Michael Mello
- Brown University, Department of Emergency Medicine, Providence, Rhode Island
- Rhode Island Hospital, Injury Prevention Center, Providence, Rhode Island
- Brown University, School of Public Health, Providence, Rhode Island
| | - Bryan Choi
- Brown University, Department of Emergency Medicine, Providence, Rhode Island
- Brown University, School of Public Health, Providence, Rhode Island
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Møller TP, Ersbøll AK, Tolstrup JS, Østergaard D, Viereck S, Overton J, Folke F, Lippert F. Why and when citizens call for emergency help: an observational study of 211,193 medical emergency calls. Scand J Trauma Resusc Emerg Med 2015; 23:88. [PMID: 26530307 PMCID: PMC4632270 DOI: 10.1186/s13049-015-0169-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 10/28/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND A medical emergency call is citizens' access to pre-hospital emergency care and ambulance services. Emergency medical dispatchers are gatekeepers to provision of pre-hospital resources and possibly hospital admissions. We explored causes for access, emergency priority levels, and temporal variation within seasons, weekdays, and time of day for emergency calls to the emergency medical dispatch center in Copenhagen in a two-year study period (December 1(st), 2011 to November 30(th), 2013). METHODS Descriptive analysis was performed for causes for access and emergency priority levels. A Poisson regression model was used to calculate adjusted ratio estimates for the association between seasons, weekdays, and time of day overall and stratified by emergency priority levels. RESULTS We analyzed 211,193 emergency calls for temporal variation. Of those, 167,635 calls were eligible for analysis of causes and emergency priority level. "Unclear problem" was the most frequent category (19%). The five most common causes with known origin were categorized as "Wounds, fractures, minor injuries" (13%), "Chest pain/heart disease" (11%), "Accidents" (9%), "Intoxication, poisoning, drug overdose" (8%), and "Breathing difficulties" (7%). The highest emergency priority levels (Emergency priority level A and B) were assigned in 81% of calls. In the analysis of temporal variation, the total number of calls peaked at wintertime (26%), Saturdays (16%), and during daytime (39%). CONCLUSION The pattern of citizens' contact causes fell into four overall categories: unclear problems, medical problems, intoxication and accidents. The majority of calls were urgent. The magnitude of unclear problems represents a modifiable factor and highlights the potential for further improvement of supportive dispatch priority tools or educational interventions at dispatch centers. Temporal variation was identified within seasons, weekdays and time of day and reflects both system load and disease occurrence. Data on contact patterns could be utilized in a public health perspective, benchmarking of EMS systems, and ultimately development of best practice in the area of emergency medicine.
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Affiliation(s)
- Thea Palsgaard Møller
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark.
| | - Annette Kjær Ersbøll
- National Institute of Public health, University of Southern Denmark, Copenhagen, Denmark.
| | | | - Doris Østergaard
- Danish Institute for Medical Simulation, University of Copenhagen, Copenhagen, Denmark.
| | - Søren Viereck
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark.
| | - Jerry Overton
- International Academies of Emergency Dispatch, Salt Lake City, Utah, USA.
| | - Fredrik Folke
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark.
| | - Freddy Lippert
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark.
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Booker MJ, Shaw ARG, Purdy S. Why do patients with 'primary care sensitive' problems access ambulance services? A systematic mapping review of the literature. BMJ Open 2015; 5:e007726. [PMID: 25991458 PMCID: PMC4442240 DOI: 10.1136/bmjopen-2015-007726] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Emergency ambulance use for problems that could be managed in primary care continues to rise owing to complex reasons that are poorly understood. The objective of this systematic review is to draw together published evidence across a variety of study methodologies and settings to gain a better understanding of why patients seek help from ambulance services for these problems. DESIGN Systematic searches were undertaken across the MEDLINE, EMBASE, PsychINFO, CINAHL, Health Management Information Consortium and Health Management Information Service publication databases. Google Scholar, Web of Science, OpenSigle, EThOS and DART databases were also systematically searched for reports, proceedings, book chapters and theses, along with hand-searching of grey literature sources. Studies were included if they reported on findings examining patient, carer, health professional or service management interactions with ambulance services for primary care problems. All study methodologies and perspectives were of interest. Data were extracted, quality assessed and systematically mapped according to key findings through generation of an iterative framework. RESULTS A total of 31 studies met inclusion criteria. Findings were summarised across 5 broad categories: factors associated with individual patients; actions of care-givers and bystanders; population-level factors; health infrastructure factors; challenges faced by health professionals. A number of subcategories were developed to explore these factors in more detail. CONCLUSIONS This review reports important factors that may impact on ambulance use for primary care problems across a global setting, including demographic measures associated with deprivation, minority status and individual social circumstances. Categorising ambulance calls for primary care problems as 'inappropriate' is context dependant and may be unhelpful. Potential implications for triage and risk management strategies are discussed.
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Affiliation(s)
- Matthew J Booker
- Centre for Academic Primary Care, School of Social and Community Medicine University of Bristol, Bristol, UK
| | - Ali R G Shaw
- Centre for Academic Primary Care, School of Social and Community Medicine University of Bristol, Bristol, UK
| | - Sarah Purdy
- Centre for Academic Primary Care, School of Social and Community Medicine University of Bristol, Bristol, UK
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Snooks HA, Carter B, Dale J, Foster T, Humphreys I, Logan PA, Lyons RA, Mason SM, Phillips CJ, Sanchez A, Wani M, Watkins A, Wells BE, Whitfield R, Russell IT. Support and Assessment for Fall Emergency Referrals (SAFER 1): cluster randomised trial of computerised clinical decision support for paramedics. PLoS One 2014; 9:e106436. [PMID: 25216281 PMCID: PMC4162545 DOI: 10.1371/journal.pone.0106436] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 08/05/2014] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate effectiveness, safety and cost-effectiveness of Computerised Clinical Decision Support (CCDS) for paramedics attending older people who fall. Design Cluster trial randomised by paramedic; modelling. Setting 13 ambulance stations in two UK emergency ambulance services. Participants 42 of 409 eligible paramedics, who attended 779 older patients for a reported fall. Interventions Intervention paramedics received CCDS on Tablet computers to guide patient care. Control paramedics provided care as usual. One service had already installed electronic data capture. Main Outcome Measures Effectiveness: patients referred to falls service, patient reported quality of life and satisfaction, processes of care. Safety Further emergency contacts or death within one month. Cost-Effectiveness Costs and quality of life. We used findings from published Community Falls Prevention Trial to model cost-effectiveness. Results 17 intervention paramedics used CCDS for 54 (12.4%) of 436 participants. They referred 42 (9.6%) to falls services, compared with 17 (5.0%) of 343 participants seen by 19 control paramedics [Odds ratio (OR) 2.04, 95% CI 1.12 to 3.72]. No adverse events were related to the intervention. Non-significant differences between groups included: subsequent emergency contacts (34.6% versus 29.1%; OR 1.27, 95% CI 0.93 to 1.72); quality of life (mean SF12 differences: MCS −0.74, 95% CI −2.83 to +1.28; PCS −0.13, 95% CI −1.65 to +1.39) and non-conveyance (42.0% versus 36.7%; OR 1.13, 95% CI 0.84 to 1.52). However ambulance job cycle time was 8.9 minutes longer for intervention patients (95% CI 2.3 to 15.3). Average net cost of implementing CCDS was £208 per patient with existing electronic data capture, and £308 without. Modelling estimated cost per quality-adjusted life-year at £15,000 with existing electronic data capture; and £22,200 without. Conclusions Intervention paramedics referred twice as many participants to falls services with no difference in safety. CCDS is potentially cost-effective, especially with existing electronic data capture. Trial Registration ISRCTN Register ISRCTN10538608
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Affiliation(s)
- Helen Anne Snooks
- Institute of Life Science, College of Medicine, Swansea University, Singleton Park, Swansea, United Kingdom
- * E-mail:
| | - Ben Carter
- Institute of Primary Care & Public Health, Cardiff University School of Medicine, Neuadd Meirionnydd, Heath Park, Cardiff, United Kingdom
| | - Jeremy Dale
- Warwick Medical School, Gibbet Hill Campus, University of Warwick, Coventry, United Kingdom
| | - Theresa Foster
- East of England Ambulance Service NHS Trust, Milford Service Area, Fiveways Roundabout, Barton Mills, Suffolk, United Kingdom
| | - Ioan Humphreys
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, United Kingdom
| | - Philippa Anne Logan
- Division of Rehabilitation and Ageing, School of Community Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Ronan Anthony Lyons
- Institute of Life Science, College of Medicine, Swansea University, Singleton Park, Swansea, United Kingdom
| | - Suzanne Margaret Mason
- School of Health and Related Research, Sheffield University, Regent Court, Sheffield, United Kingdom
| | - Ceri James Phillips
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, United Kingdom
| | - Antonio Sanchez
- Department of Medicine, Cardiff University, Academic Building, Llandough Hospital, Penarth, United Kingdom
| | - Mushtaq Wani
- Abertawe Bro Morgannwg University Health Board, Department of Stroke Medicine, Morriston Hospital, Morriston, Swansea, United Kingdom
| | - Alan Watkins
- Institute of Life Science, College of Medicine, Swansea University, Singleton Park, Swansea, United Kingdom
| | - Bridget Elizabeth Wells
- Institute of Life Science, College of Medicine, Swansea University, Singleton Park, Swansea, United Kingdom
| | - Richard Whitfield
- Prehospital Emergency Research Unit, Welsh Ambulance Services NHS Trust, Lansdowne Hospital, Canton, Cardiff, United Kingdom
| | - Ian Trevor Russell
- Institute of Life Science, College of Medicine, Swansea University, Singleton Park, Swansea, United Kingdom
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HØJFELDT SG, SØRENSEN LP, MIKKELSEN S. Emergency patients receiving anaesthesiologist-based pre-hospital treatment and subsequently released at the scene. Acta Anaesthesiol Scand 2014; 58:1025-31. [PMID: 24888864 DOI: 10.1111/aas.12347] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Mobile Emergency Care Unit in Odense, Denmark consists of a rapid response car, manned with an anaesthesiologist and an emergency medical technician. Eleven per cent of the patients are released at the scene following treatment. The aim of the study was to investigate which diagnoses were assigned to patients released at the scene following treatment, to investigate the need for secondary contact with the hospital and to assess mortality in patients released at the scene. METHODS All records regarding patients released at the scene from 1 January 2008 to 31 December 2010 were investigated. In each patient, diagnosis as well as any renewed contact with the Mobile Emergency Care Unit or the hospital within 24 h was registered. RESULTS One thousand six hundred nine: patients were released at the scene. Diagnoses within the category 'examination and investigation' [International Classification of Diseases 10th revision (ICD-10) chapter XXI] represented the largest group of patients (28%). Diseases not elsewhere classified (ICD-10 chapter XVIII) including 'syncope and collapse' represented the second largest group of patients (24%). One hundred thirteen (7%) had a renewed contact with the Mobile Emergency Care Unit within 24 h. Of the 143 victims of traffic accidents, 19 (13%) required renewed contact with the emergency department and one required admission to hospital (0.7%). Of all 1609 patients, four died within 24 h of contact (0.2%). CONCLUSION Patients treated and released at the scene presented poorly defined conditions. Ninety-three per cent of all cases required no secondary contacts with the health care system. However, caution should be exercised when releasing patients at the scene following traffic accidents.
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Affiliation(s)
- S. G. HØJFELDT
- Mobile Emergency Care Unit; Department of Anaesthesiology and Intensive Care; Odense University Hospital; Odense Denmark
| | - L. P. SØRENSEN
- Mobile Emergency Care Unit; Department of Anaesthesiology and Intensive Care; Odense University Hospital; Odense Denmark
| | - S. MIKKELSEN
- Mobile Emergency Care Unit; Department of Anaesthesiology and Intensive Care; Odense University Hospital; Odense Denmark
- Institute of Clinical Research; University of Southern Denmark; Odense Denmark
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Sibson L. The use of telemedicine technology to support in pre-hospital patient care. ACTA ACUST UNITED AC 2014. [DOI: 10.12968/jpar.2014.6.7.344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lynda Sibson
- independent nusres consultant; lecturer, FD Paramedic Studies, Coventry University; telemedicine project manager, Addenbrooke's Hospital, Cambridge
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Eastwood K, Morgans A, Smith K, Stoelwinder J. Secondary triage in prehospital emergency ambulance services: a systematic review. Emerg Med J 2014; 32:486-92. [PMID: 24788598 DOI: 10.1136/emermed-2013-203120] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 03/30/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Secondary telephone triage to divert low-acuity patients to alternative non-ambulance services before ambulance arrival has been trialled in the UK and USA as a management strategy to cope with the increase in ambulance demand. The objective of this systematic review was to examine the literature on the structure, safety and success of secondary triage systems. METHODS For inclusion in the study, the telephone triage system had to be a secondary process, receiving referred patients who had already been categorised as low priority by a primary triage process. Two independent reviewers conducted the search to identify relevant studies. Six articles and one report were identified. RESULTS The major theme of the papers was the safety and accuracy of secondary telephone triage in identifying low-acuity patients. Two studies also discussed patient satisfaction. There was a low incidence of adverse events, as expected as these patients had already been subjected to primary telephone triage. In the studies identifying ambulance dispatch as a potential final disposition, at least half of the patients were diverted away from ambulance dispatch. In the studies that identified self/home care as a final disposition, a maximum of 31% of patients were categorised to this outcome. Otherwise all patients were recommended for assessment by a healthcare professional other than ambulance clinicians. Patients appeared to be satisfied with secondary telephone triage on follow-up. CONCLUSIONS These results suggest that, while secondary triage of these patients is safe, further research is required to determine its most appropriate structure and its effect on ambulance demand.
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Affiliation(s)
- Kathryn Eastwood
- Department of Epidemiology and Preventative Medicine, The Alfred Centre, Monash University, Melbourne, Victoria, Australia Ambulance Victoria, Melbourne, Victoria, Australia Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Victoria, Australia
| | - Amee Morgans
- Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Victoria, Australia
| | - Karen Smith
- Department of Epidemiology and Preventative Medicine, The Alfred Centre, Monash University, Melbourne, Victoria, Australia Ambulance Victoria, Melbourne, Victoria, Australia
| | - Johannes Stoelwinder
- Department of Epidemiology and Preventative Medicine, The Alfred Centre, Monash University, Melbourne, Victoria, Australia Ambulance Victoria, Melbourne, Victoria, Australia
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Simpson PM, Bendall JC, Tiedemann A, Lord SR, Close JCT. Epidemiology of Emergency Medical Service Responses to Older People Who Have Fallen: A Prospective Cohort Study. PREHOSP EMERG CARE 2014; 18:185-94. [DOI: 10.3109/10903127.2013.856504] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mikolaizak AS, Simpson PM, Tiedemann A, Lord SR, Caplan GA, Bendall JC, Howard K, Close JCT. Intervention to prevent further falls in older people who call an ambulance as a result of a fall: a protocol for the iPREFER randomised controlled trial. BMC Health Serv Res 2013; 13:360. [PMID: 24070456 PMCID: PMC3849451 DOI: 10.1186/1472-6963-13-360] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 09/18/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An increasing number of falls result in an emergency call and the subsequent dispatch of paramedics. In the absence of physical injury, abnormal physiological parameters or change in usual functional status, it could be argued that routine conveyance by ambulance to the Emergency Department (ED) is not the most effective or efficient use of resources. Further, it is likely that non-conveyed older fallers have the potential to benefit from timely access to fall risk assessment and intervention. The aim of this randomised controlled trial is to evaluate the effect of a timely and tailored falls assessment and management intervention on the number of subsequent falls and fall-related injuries for non-conveyed older fallers. METHODS Community dwelling people aged 65 years or older who are not conveyed to the ED following a fall will be eligible to be visited at home by a research physiotherapist. Consenting participants will receive individualised intervention strategies based on risk factors identified at baseline. All pre-test measures will be assessed prior to randomisation. Post-test measures will be undertaken by a researcher blinded to group allocation 6 months post-baseline. Participants in the intervention group will receive individualised pro-active fall prevention strategies from the clinical researcher to ensure that risk factors are addressed adequately and interventions carried out. The primary outcome measure will be the number of falls recorded by a falls diary over a 12 month period. Secondary outcome measures assessed six months after baseline will include the subsequent use of medical and emergency services and uptake of recommendations. Data will be analysed using the intention-to-treat principle. DISCUSSION As there is currently little evidence regarding the effectiveness or feasibility of alternate models of care following ambulance non-conveyance of older fallers, there is a need to explore assessment and intervention programs to help reduce subsequent falls, related injuries and subsequent use of health care services. By linking existing services rather than setting up new services, this pragmatic trial aims to utilise the health care system in an efficient and timely manner. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN 12611000503921.
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Affiliation(s)
- A Stefanie Mikolaizak
- Neuroscience Research Australia, University of New South Wales, Barker Street, Randwick, 2031 Sydney, NSW, Australia
| | | | - Anne Tiedemann
- The George Institute for Global Health, The University of Sydney, Sydney, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, University of New South Wales, Barker Street, Randwick, 2031 Sydney, NSW, Australia
| | - Gideon A Caplan
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | | | - Kirsten Howard
- School of Public Health, University of Sydney, Sydney, Australia
| | - Jacqueline CT Close
- Neuroscience Research Australia, University of New South Wales, Barker Street, Randwick, 2031 Sydney, NSW, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
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Infinger A, Studnek JR, Hawkins E, Bagwell B, Swanson D. Implementation of prehospital dispatch protocols that triage low-acuity patients to advice-line nurses. PREHOSP EMERG CARE 2013; 17:481-5. [PMID: 23865776 DOI: 10.3109/10903127.2013.811563] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Although EMS agencies have been designed to efficiently provide medical assistance to individuals, the overuse of 9-1-1 as an alternative to primary medical care has resulted in the need for new methods to respond to this increasing demand. Our study analyzes the efficacy of classifying specific low-acuity calls that can be transferred to an advice-line nurse for further medical instruction. The objectives of our study were to analyze the impact of implementing this protocol and resultant patient feedback regarding the transfer to an advice-line nurse. METHODS We collected data for retrospective review from April 2011 to April 2012 from a single municipal EMS agency with an average annual call volume of approximately 90,000. Medical Priority Dispatch System response codes were assigned to calls based on patient acuity. Patients classified under Omega response codes were assessed for eligibility of transfer to nurse advice lines. Exclusion criteria included the following: if the call was placed by a third-party caller; if the patient refused to be transferred to the advice-line nurse; anytime the MPDS system was not used; if the patient was referred from a skilled nursing facility, school, or university nursing office, or physician's office. Telephone surveys were conducted for those patients who spoke to an advice-line nurse and did not receive an ambulance response 24 hours after calling 9-1-1 to obtain patient feedback. RESULTS The database included 1660 patients initially classified as Omega and eligible for transfer to an advice-line nurse. After applying the exclusion criteria, 329 (19.8%) patients were ultimately transferred to an advice-line nurse and 204 (12.3%) received no ambulance response. Of those patients who were not transported by ambulance 118 (57.8%), patients completed telephone follow-up, with 104 (88.1%) reporting the nontransport option met their health-care needs and 108 (91.5%) responding they would accept the transfer again for a similar complaint. CONCLUSION We identified an average of two patients per day as eligible for transfer to the nurse advice line, with less than one patient successfully completing the Omega protocol per day. While impact was limited, there was a decrease in ambulance response.
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Affiliation(s)
- Allison Infinger
- University of North Carolina -Charlotte, Charlotte, North Carolina, USA
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Mikolaizak AS, Simpson PM, Tiedemann A, Lord SR, Close JCT. Systematic review of non-transportation rates and outcomes for older people who have fallen after ambulance service call-out. Australas J Ageing 2013; 32:147-57. [PMID: 24028454 DOI: 10.1111/ajag.12023] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To review the evidence regarding non-transported older people who have fallen in relation to non-transportation rates, outcomes and impact of alternate care pathways. METHOD Electronic databases and reference lists of included studies (up to December 2011) were systematically searched. Studies were eligible if they included data on non-transportation rates, information on outcomes or alternate care pathways for older people who have fallen. RESULTS Twelve studies were included. Non-transportation rates following a fall ranged from 11% to 56%. Up to 49% of non-transported people who have fallen had unplanned health-care contact within 28 days of the initial incident. Attendance by specially trained paramedics and individualised multifactorial interventions significantly reduced adverse events including subsequent falls, emergency ambulance calls, emergency department attendance and hospital admission. CONCLUSION Limited but promising evidence shows that appropriate interventions can improve health outcomes of non-transported older people who have fallen. Further studies are needed to explore alternate care pathways and promote more efficient use of health services.
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Affiliation(s)
- A Stefanie Mikolaizak
- Neuroscience Research Australia, University of New South Wales, Sydney, New South Wales, Australia
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Booker MJ, Simmonds RL, Purdy S. Patients who call emergency ambulances for primary care problems: a qualitative study of the decision-making process. Emerg Med J 2013; 31:448-52. [PMID: 23535018 DOI: 10.1136/emermed-2012-202124] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Telephone calls for emergency ambulances are rising annually, increasing the pressure on ambulance resources for clinical problems that could often be appropriately managed in primary care. OBJECTIVE To explore and understand patient and carer decision making around calling an ambulance for primary care-appropriate health problems. METHODS Semistructured interviews were conducted with patients and carers who had called an ambulance for a primary care-appropriate problem. Participants were identified using a purposive sampling method by a non-participating research clinician attending '999' ambulance calls. A thematic analysis of interview transcripts was undertaken. RESULTS A superordinate theme, patient and carer anxiety in urgent-care decision making, and four subthemes were explored: perceptions of ambulance-based urgent care; contrasting perceptions of community-based urgent care; influence of previous urgent care experiences in decision making; and interpersonal factors in lay assessment and management of medical risk and subsequent decision making. CONCLUSIONS Many calls are based on fundamental misconceptions about the types of treatment other urgent-care avenues can provide, which may be amenable to educational intervention. This is particularly relevant for patients with chronic conditions with frequent exacerbations. Callers who have care responsibilities often default to the most immediate response available, with decision making driven by a lower tolerance of perceived risk. There may be a greater role for more detailed triage in these cases, and closer working between ambulance responses and urgent primary care, as a perceived or actual distance between these two service sectors may be influencing patient decision making on urgent care.
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Affiliation(s)
- Matthew J Booker
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Rosemary L Simmonds
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Sarah Purdy
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
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Studnek JR, Thestrup L, Blackwell T, Bagwell B. Utilization of Prehospital Dispatch Protocols to Identify Low-Acuity Patients. PREHOSP EMERG CARE 2012; 16:204-9. [DOI: 10.3109/10903127.2011.640415] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Snooks H, Anthony R, Chatters R, Cheung WY, Dale J, Donohoe R, Gaze S, Halter M, Koniotou M, Logan P, Lyons R, Mason S, Nicholl J, Phillips C, Phillips J, Russell I, Siriwardena AN, Wani M, Watkins A, Whitfield R, Wilson L. Support and assessment for fall emergency referrals (SAFER 2) research protocol: cluster randomised trial of the clinical and cost effectiveness of new protocols for emergency ambulance paramedics to assess and refer to appropriate community-based care. BMJ Open 2012; 2:bmjopen-2012-002169. [PMID: 23148348 PMCID: PMC3533098 DOI: 10.1136/bmjopen-2012-002169] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Emergency calls to ambulance services are frequent for older people who have fallen, but ambulance crews often leave patients at the scene without ongoing care. Evidence shows that when left at home with no further support older people often experience subsequent falls which result in injury and emergency-department attendances. SAFER 2 is an evaluation of a new clinical protocol which allows paramedics to assess and refer older people who have fallen, and do not need hospital care, to community-based falls services. In this protocol paper, we report methods and progress during trial implementation. SAFER 2 is recruiting patients through three ambulance services. A successful trial will provide robust evidence about the value of this new model of care, and enable ambulance services to use resources efficiently. DESIGN Pragmatic cluster randomised trial. METHODS AND ANALYSIS We randomly allocated 25 participating ambulance stations (clusters) in three services to intervention or control group. Intervention paramedics received training and clinical protocols for assessing and referring older people who have fallen to community-based falls services when appropriate, while control paramedics deliver care as usual. Patients are eligible for the trial if they are aged 65 or over; resident in a participating falls service catchment area; and attended by a trial paramedic following an emergency call coded as a fall without priority symptoms. The principal outcome is the rate of further emergency contacts (or death), for any cause and for falls. Secondary outcomes include further falls, health-related quality of life, 'fear of falling', patient satisfaction reported by participants through postal questionnaires at 1 and 6 months, and quality and pathways of care at the index incident. We shall compare National Health Service (NHS) and patient/carer costs between intervention and control groups and estimate quality-adjusted life years (QALYs) gained from the intervention and thus incremental cost per QALY. We shall estimate wider system effects on key-performance indicators. We shall interview 60 intervention patients, and conduct focus groups with contributing NHS staff to explore their experiences of the assessment and referral service. We shall analyse quantitative trial data by 'treatment allocated'; and qualitative data using content analysis. ETHICS AND DISSEMINATION The Research Ethics Committee for Wales gave ethical approval and each participating centre gave NHS Research and Development approval. We shall disseminate study findings through peer-reviewed publications and conference presentations. TRIAL REGISTRATION ISRCTN 60481756.
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Affiliation(s)
- Helen Snooks
- Centre for Health Information Research and Evaluation, Swansea University, Swansea, UK
| | - Rebecca Anthony
- Centre for Health Information Research and Evaluation, Swansea University, Swansea, UK
| | - Robin Chatters
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Wai-Yee Cheung
- Centre for Health Information Research and Evaluation, Swansea University, Swansea, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachael Donohoe
- Clinical Audit and Research Unit, London Ambulance Service NHS Trust, London, UK
| | - Sarah Gaze
- Centre for Health Information Research and Evaluation, Swansea University, Swansea, UK
| | - Mary Halter
- Faculty of Health and Social Services, St Georges University Hospital, London, UK
| | - Marina Koniotou
- Centre for Health Information Research and Evaluation, Swansea University, Swansea, UK
| | - Phillippa Logan
- Community Health Sciences, The University of Nottingham, Nottingham, UK
| | - Ronan Lyons
- Centre for Health Information Research and Evaluation, Swansea University, Swansea, UK
| | - Suzanne Mason
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jon Nicholl
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Ceri Phillips
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Judith Phillips
- Centre for Innovative Ageing, Swansea University, Swansea, UK
| | - Ian Russell
- West Wales Organisation for Rigorous Trials in Health, College of Medicine, Swansea, UK
| | | | - Mushtaq Wani
- Department of Geriatric and Stroke Medicine, Morriston Hospital, Swansea, UK
| | - Alan Watkins
- School of Business and Economics, Swansea University, Swansea, UK
| | - Richard Whitfield
- Pre-hospital Emergency Research Unit (PERU), Welsh Ambulance Services NHS Trust, Cardiff, UK
| | - Lynsey Wilson
- Centre for Health Information Research and Evaluation, Swansea University, Swansea, UK
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47
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Wu O, Briggs A, Kemp T, Gray A, MacIntyre K, Rowley J, Willett K. Mobile phone use for contacting emergency services in life-threatening circumstances. J Emerg Med 2011; 42:291-298.e3. [PMID: 22142669 DOI: 10.1016/j.jemermed.2011.02.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 09/15/2010] [Accepted: 02/18/2011] [Indexed: 11/15/2022]
Abstract
BACKGROUND The potential health benefits of mobile phone use have not been widely studied, except for telemedicine-type applications. STUDY OBJECTIVES This study seeks to determine whether initial contact with emergency services via a mobile phone in life-threatening situations is associated with potential health benefits when compared to contact via a landline. METHODS A record-linkage study was carried out in which data from all emergency dispatches for immediately life-threatening events from a United Kingdom county ambulance service were linked to the Patient Admission System at two major local hospitals. Mortality (at the scene, at the emergency department [ED], and during hospitalization); transfer to the ED; admission (inpatient care, and intensive care unit); and length of stay were analyzed for calls classified as Code Red (immediately life-threatening) by initial exposure (mobile phone vs. landline), while controlling for potential confounding variables. RESULTS Of 354,199 ambulances dispatched to attend emergency incidents, 66% transported patients to the hospital while 2% stood down due to death at the scene. Mobile phone compared to landline reporting of emergencies resulted in significant reductions in the risk of death at the scene (odds ratio [OR] 0.77), but not for death in the ED or during inpatient admission. The risk of being transferred to the ED and subsequent inpatient admission were significantly lower with reporting from mobile phones compared to landline (OR 0.93 and OR 0.82, respectively). CONCLUSIONS In this study, evidence of statistical association was demonstrated between the use of mobile phones to alert ambulance services in life-threatening situations and improved outcomes for patients.
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Affiliation(s)
- Olivia Wu
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Rashford S, Isoardi K. Optimizing the appropriate use of the emergency call system, and dealing with hoax callers. Emerg Med Australas 2010; 22:366-7. [PMID: 21040478 DOI: 10.1111/j.1742-6723.2010.01325.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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49
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Logan PA, Coupland CAC, Gladman JRF, Sahota O, Stoner-Hobbs V, Robertson K, Tomlinson V, Ward M, Sach T, Avery AJ. Community falls prevention for people who call an emergency ambulance after a fall: randomised controlled trial. BMJ 2010; 340:c2102. [PMID: 20460331 PMCID: PMC2868162 DOI: 10.1136/bmj.c2102] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate whether a service to prevent falls in the community would help reduce the rate of falls in older people who call an emergency ambulance when they fall but are not taken to hospital. DESIGN Randomised controlled trial. SETTING Community covered by four primary care trusts, England. PARTICIPANTS 204 adults aged more than 60 living at home or in residential care who had fallen and called an emergency ambulance but were not taken to hospital. INTERVENTIONS Referral to community fall prevention services or standard medical and social care. MAIN OUTCOME MEASURES The primary outcome was the rate of falls over 12 months, ascertained from monthly diaries. Secondary outcomes were scores on the Barthel index, Nottingham extended activities of daily living scale, and falls efficacy scale at baseline and by postal questionnaire at 12 months. Analysis was by intention to treat. RESULTS 102 people were allocated to each group. 99 (97%) participants in the intervention group received the intervention. Falls diaries were analysed for 88.6 person years in the intervention group and 84.5 person years in the control group. The incidence rates of falls per year were 3.46 in the intervention group and 7.68 in the control group (incidence rate ratio 0.45, 95% confidence interval 0.35 to 0.58, P<0.001). The intervention group achieved higher scores on the Barthel index and Nottingham extended activities of daily living and lower scores on the falls efficacy scale (all P<0.05) at the 12 month follow-up. The number of times an emergency ambulance was called because of a fall was significantly different during follow-up (incidence rate ratio 0.60, 95% confidence interval 0.40 to 0.92, P=0.018). CONCLUSION A service to prevent falls in the community reduced the fall rate and improved clinical outcome in the high risk group of older people who call an emergency ambulance after a fall but are not taken to hospital. TRIAL REGISTRATION Current Controlled Trials ISRCTN67535605.
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50
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Holmberg M, Fagerberg I. The encounter with the unknown: Nurses lived experiences of their responsibility for the care of the patient in the Swedish ambulance service. Int J Qual Stud Health Well-being 2010; 5:5098. [PMID: 20640018 PMCID: PMC2875973 DOI: 10.3402/qhw.v5i2.5098] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Indexed: 11/14/2022] Open
Abstract
Registered nurses (RNs) have, according to the Swedish National Board of Health and Welfare, the overall responsibility for the medical care in the ambulance care setting. Bringing RNs into the ambulance service are judged, according to earlier studies, to lead to a degree of professionalism with a higher quality of medical care. Implicitly in earlier studies, the work in the ambulance service involves interpersonal skills. The aim of this study was to describe RNs' experiences of being responsible for the care of the patient in the Swedish ambulance service. A reflective lifeworld approach within the perspective of caring science was used. Five RNs with at least five years experience from care in the ambulance care setting were interviewed. The findings show that the essence of the phenomenon is to prepare and create conditions for care and to accomplish care close to the patient. Three meaning constituents emerged in the descriptions: prepare and create conditions for the nursing care, to be there for the patient and significant others and create comfort for the patient and significant others. The responsibility is a complex phenomenon, with a caring perspective, emerging from the encounter with the unique human being.
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Affiliation(s)
- Mats Holmberg
- Ambulance Service Department, Sörmland County Council, Katrineholm, Sweden
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