A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review
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 ca...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2017-07-01
|
| Series: | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13049-017-0409-6 |
| _version_ | 1818978519843078144 |
|---|---|
| author | Remco H.A. Ebben Lilian C.M. Vloet Renate F. Speijers Nico W. Tönjes Jorik Loef Thomas Pelgrim Margreet Hoogeveen Sivera A.A. Berben |
| author_facet | Remco H.A. Ebben Lilian C.M. Vloet Renate F. Speijers Nico W. Tönjes Jorik Loef Thomas Pelgrim Margreet Hoogeveen Sivera A.A. Berben |
| author_sort | Remco H.A. Ebben |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-20T16:44:56Z |
| format | Article |
| id | doaj.art-744f21ba3fd247308f231cbdf3be7658 |
| institution | Directory Open Access Journal |
| issn | 1757-7241 |
| language | English |
| last_indexed | 2024-12-20T16:44:56Z |
| publishDate | 2017-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| spelling | doaj.art-744f21ba3fd247308f231cbdf3be76582022-12-21T19:32:57ZengBMCScandinavian Journal of Trauma, Resuscitation and Emergency Medicine1757-72412017-07-0125112010.1186/s13049-017-0409-6A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic reviewRemco H.A. Ebben0Lilian C.M. Vloet1Renate F. Speijers2Nico W. Tönjes3Jorik Loef4Thomas Pelgrim5Margreet Hoogeveen6Sivera A.A. Berben7Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Faculty of Health and Social StudiesResearch Department of Emergency and Critical Care, HAN University of Applied Sciences, Faculty of Health and Social StudiesResearch Department of Emergency and Critical Care, HAN University of Applied Sciences, Faculty of Health and Social StudiesResearch Department of Emergency and Critical Care, HAN University of Applied Sciences, Faculty of Health and Social StudiesResearch Department of Emergency and Critical Care, HAN University of Applied Sciences, Faculty of Health and Social StudiesResearch Department of Emergency and Critical Care, HAN University of Applied Sciences, Faculty of Health and Social StudiesDutch National Sector Organisation for Ambulance CareResearch Department of Emergency and Critical Care, HAN University of Applied Sciences, Faculty of Health and Social StudiesAbstract 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.http://link.springer.com/article/10.1186/s13049-017-0409-6Emergency medical services [MeSH]Patient safety [MeSH]Clinical competence [MeSH]Non-conveyance |
| spellingShingle | Remco H.A. Ebben Lilian C.M. Vloet Renate F. Speijers Nico W. Tönjes Jorik Loef Thomas Pelgrim Margreet Hoogeveen Sivera A.A. Berben A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Emergency medical services [MeSH] Patient safety [MeSH] Clinical competence [MeSH] Non-conveyance |
| title | A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review |
| title_full | A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review |
| title_fullStr | A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review |
| title_full_unstemmed | A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review |
| title_short | A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review |
| title_sort | patient safety and professional perspective on non conveyance in ambulance care a systematic review |
| topic | Emergency medical services [MeSH] Patient safety [MeSH] Clinical competence [MeSH] Non-conveyance |
| url | http://link.springer.com/article/10.1186/s13049-017-0409-6 |
| work_keys_str_mv | AT remcohaebben apatientsafetyandprofessionalperspectiveonnonconveyanceinambulancecareasystematicreview AT liliancmvloet apatientsafetyandprofessionalperspectiveonnonconveyanceinambulancecareasystematicreview AT renatefspeijers apatientsafetyandprofessionalperspectiveonnonconveyanceinambulancecareasystematicreview AT nicowtonjes apatientsafetyandprofessionalperspectiveonnonconveyanceinambulancecareasystematicreview AT jorikloef apatientsafetyandprofessionalperspectiveonnonconveyanceinambulancecareasystematicreview AT thomaspelgrim apatientsafetyandprofessionalperspectiveonnonconveyanceinambulancecareasystematicreview AT margreethoogeveen apatientsafetyandprofessionalperspectiveonnonconveyanceinambulancecareasystematicreview AT siveraaaberben apatientsafetyandprofessionalperspectiveonnonconveyanceinambulancecareasystematicreview AT remcohaebben patientsafetyandprofessionalperspectiveonnonconveyanceinambulancecareasystematicreview AT liliancmvloet patientsafetyandprofessionalperspectiveonnonconveyanceinambulancecareasystematicreview AT renatefspeijers patientsafetyandprofessionalperspectiveonnonconveyanceinambulancecareasystematicreview AT nicowtonjes patientsafetyandprofessionalperspectiveonnonconveyanceinambulancecareasystematicreview AT jorikloef patientsafetyandprofessionalperspectiveonnonconveyanceinambulancecareasystematicreview AT thomaspelgrim patientsafetyandprofessionalperspectiveonnonconveyanceinambulancecareasystematicreview AT margreethoogeveen patientsafetyandprofessionalperspectiveonnonconveyanceinambulancecareasystematicreview AT siveraaaberben patientsafetyandprofessionalperspectiveonnonconveyanceinambulancecareasystematicreview |