EMS non-conveyance: A safe practice to decrease ED crowding or a threat to patient safety?
Abstract Background The safety of the Emergency Medical Service’s (EMS’s) non-conveyance decision was evaluated by EMS re-contacts, primary health care or emergency department (ED) visits, and hospitalization within 48 h. The secondary outcome was 28-day mortality. Methods This cohort study used pro...
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| Format: | Article |
| Language: | English |
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BMC
2021-10-01
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| Series: | BMC Emergency Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12873-021-00508-1 |
| _version_ | 1818987272479965184 |
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| author | Jani Paulin Jouni Kurola Mari Koivisto Timo Iirola |
| author_facet | Jani Paulin Jouni Kurola Mari Koivisto Timo Iirola |
| author_sort | Jani Paulin |
| collection | DOAJ |
| description | Abstract Background The safety of the Emergency Medical Service’s (EMS’s) non-conveyance decision was evaluated by EMS re-contacts, primary health care or emergency department (ED) visits, and hospitalization within 48 h. The secondary outcome was 28-day mortality. Methods This cohort study used prospectively collected data on non-conveyed EMS patients from three different regions in Finland between June 1 and November 30, 2018. The Adjusted International Classification of Primary Care (ICPC2) as the reason for care was compared to hospital discharge diagnoses (ICD10). Multivariable logistic regressions were used to determine factors that were independently associated with adverse outcomes. Results are presented with adjusted odds ratios (aORs) together with 95% confidence intervals (CIs). Data regarding deceased patients were reviewed by the study group. Results Of the non-conveyed EMS patients (n = 11,861), 6.3% re-contacted the EMS, 8.3% attended a primary health care facility, 4.2% went to the ED, 1.6% were hospitalized, and 0.1% died 0–24 h after the EMS mission. The 0–24 h adverse event rate was higher than 24–48 h. After non-conveyance, 32 (0.3%) patients were admitted to an intensive care unit within 24 h. Primary non-urgent EMS mission (aOR 1.49; 95% CI 1.25 to 1.77), EMS arrival at night (aOR 1.82; 95% CI 1.58 to 2.09), ALS unit type vs BLS (aOR 1.43; 95% CI 1.16 to 1.77), rural area (aOR 1.74; 95% CI 1.51 to 1.99), and older patient age (aOR 1.41; 95% CI 1.20 to 1.66) were associated with subsequent primary health care visits (0–24 h). Conclusions Four in five non-conveyed patients did not have any re-contact in follow-up period. EMS non-conveyance seems to be a relatively safe method of focusing ED resources and avoiding ED crowding. |
| first_indexed | 2024-12-20T19:04:03Z |
| format | Article |
| id | doaj.art-f363c4f2db984882a95c043e7f77ba22 |
| institution | Directory Open Access Journal |
| issn | 1471-227X |
| language | English |
| last_indexed | 2024-12-20T19:04:03Z |
| publishDate | 2021-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Emergency Medicine |
| spelling | doaj.art-f363c4f2db984882a95c043e7f77ba222022-12-21T19:29:20ZengBMCBMC Emergency Medicine1471-227X2021-10-0121111310.1186/s12873-021-00508-1EMS non-conveyance: A safe practice to decrease ED crowding or a threat to patient safety?Jani Paulin0Jouni Kurola1Mari Koivisto2Timo Iirola3Department of Clinical Medicine, University of Turku and Turku University of Applied SciencesCentre for Prehospital Emergency Care, Kuopio University Hospital and University of Eastern FinlandDepartment of Biostatistics, University of TurkuEmergency Medical Services, Turku University Hospital and University of TurkuAbstract Background The safety of the Emergency Medical Service’s (EMS’s) non-conveyance decision was evaluated by EMS re-contacts, primary health care or emergency department (ED) visits, and hospitalization within 48 h. The secondary outcome was 28-day mortality. Methods This cohort study used prospectively collected data on non-conveyed EMS patients from three different regions in Finland between June 1 and November 30, 2018. The Adjusted International Classification of Primary Care (ICPC2) as the reason for care was compared to hospital discharge diagnoses (ICD10). Multivariable logistic regressions were used to determine factors that were independently associated with adverse outcomes. Results are presented with adjusted odds ratios (aORs) together with 95% confidence intervals (CIs). Data regarding deceased patients were reviewed by the study group. Results Of the non-conveyed EMS patients (n = 11,861), 6.3% re-contacted the EMS, 8.3% attended a primary health care facility, 4.2% went to the ED, 1.6% were hospitalized, and 0.1% died 0–24 h after the EMS mission. The 0–24 h adverse event rate was higher than 24–48 h. After non-conveyance, 32 (0.3%) patients were admitted to an intensive care unit within 24 h. Primary non-urgent EMS mission (aOR 1.49; 95% CI 1.25 to 1.77), EMS arrival at night (aOR 1.82; 95% CI 1.58 to 2.09), ALS unit type vs BLS (aOR 1.43; 95% CI 1.16 to 1.77), rural area (aOR 1.74; 95% CI 1.51 to 1.99), and older patient age (aOR 1.41; 95% CI 1.20 to 1.66) were associated with subsequent primary health care visits (0–24 h). Conclusions Four in five non-conveyed patients did not have any re-contact in follow-up period. EMS non-conveyance seems to be a relatively safe method of focusing ED resources and avoiding ED crowding.https://doi.org/10.1186/s12873-021-00508-1Emergency medical serviceNon-conveyanceAdverse outcomePatient safety |
| spellingShingle | Jani Paulin Jouni Kurola Mari Koivisto Timo Iirola EMS non-conveyance: A safe practice to decrease ED crowding or a threat to patient safety? BMC Emergency Medicine Emergency medical service Non-conveyance Adverse outcome Patient safety |
| title | EMS non-conveyance: A safe practice to decrease ED crowding or a threat to patient safety? |
| title_full | EMS non-conveyance: A safe practice to decrease ED crowding or a threat to patient safety? |
| title_fullStr | EMS non-conveyance: A safe practice to decrease ED crowding or a threat to patient safety? |
| title_full_unstemmed | EMS non-conveyance: A safe practice to decrease ED crowding or a threat to patient safety? |
| title_short | EMS non-conveyance: A safe practice to decrease ED crowding or a threat to patient safety? |
| title_sort | ems non conveyance a safe practice to decrease ed crowding or a threat to patient safety |
| topic | Emergency medical service Non-conveyance Adverse outcome Patient safety |
| url | https://doi.org/10.1186/s12873-021-00508-1 |
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