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Villani M, Nehme E, Cox S, Anderson D, Reinders N, Nehme Z. Outcomes of adult patients discharged at scene by emergency medical services. Emerg Med J 2024:emermed-2023-213777. [PMID: 38886060 DOI: 10.1136/emermed-2023-213777] [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: 11/19/2023] [Accepted: 06/07/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND The outcomes of patients who call an ambulance but are discharged at scene reflect the safety and quality of emergency medical service (EMS) care. While previous studies have examined the outcomes of patients discharged at scene, none have specifically focused on paramedic-initiated discharge. This study aims to describe the outcomes of adult patients discharged at scene by paramedics and identify factors associated with 72-hour outcomes. METHODS This was a retrospective data linkage study on consecutive adult EMS patients discharged at scene by paramedics in Victoria, Australia, between 1 January 2015 and 30 June 2019. Multivariable logistic regression was used to investigate factors associated with EMS recontact, ED presentation, hospital admission and serious adverse events (death, cardiac arrest, category 1 triage or intensive care unit admission) within 72 hours of the initial emergency call. RESULTS There were 375 758 cases of adults discharged at scene following EMS attendance, of which 222 571 (59.2%) were paramedic-initiated decisions. Of these, 6.8% recontacted EMS, 5.0% presented to ED, 2.4% were admitted to hospital and 0.3% had a serious adverse event in the following 72 hours. The odds of EMS recontact were increased in cases related to mental health (adjusted OR (AOR) 1.41 (95% CI 1.33 to 1.49)), among low-income government concession holders (AOR 1.61 (95% CI 1.55 to 1.67)) and in areas of low socioeconomic advantage (AOR 1.19 (95% CI 1.13 to 1.25)). The odds of hospital admission were increased in cases related to infection (AOR 3.14 (95% CI 2.80 to 3.52)) and pain (AOR 1.93 (95% CI 1.75 to 2.14)). The strongest driver of serious adverse events was an abnormal vital sign (AOR 4.81 (95% CI 3.87 to 5.98)). CONCLUSION The occurrence of hospital admission and adverse events is rare in those discharged at scene, suggesting generally safe decision-making. However, increased attention to elderly, multimorbid patients or patients with infection and pain is recommended, as is further research examining the use of tools to aid paramedic recognition of potential for deterioration.
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Affiliation(s)
- Melanie Villani
- Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Emily Nehme
- Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Shelley Cox
- Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - David Anderson
- Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care and Hyperbaric Medicine, Alfred Health, Prahran, Victoria, Australia
| | - Nicola Reinders
- Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia
| | - Ziad Nehme
- Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Holmes E, Dixon P, Mathieson A, Ridsdale L, Morgan M, McKinlay A, Dickson J, Goodacre S, Jackson M, Foster D, Hardman K, Bell S, Marson A, Hughes D, Noble AJ. Developing an alternative care pathway for emergency ambulance responses for adults with epilepsy: A Discrete Choice Experiment to understand which configuration service users prefer. Part of the COLLABORATE project. Seizure 2024; 118:28-37. [PMID: 38615478 DOI: 10.1016/j.seizure.2024.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/03/2024] [Accepted: 04/09/2024] [Indexed: 04/16/2024] Open
Abstract
INTRODUCTION To identify service users' preferences for an alternative care pathway for adults with epilepsy presenting to the ambulance service. METHODS Extensive formative work (qualitative, survey and knowledge exchange) informed the design of a stated preference discrete choice experiment (DCE). This hypothetical survey was hosted online and consisted of 12 binary choices of alternative care pathways described in terms of: the paramedic's access to medical records/ 'care plan', what happens next (described in terms of conveyance), time, availability of epilepsy specialists today, general practitioner (GP) notification and future contact with epilepsy specialists. DCE scenarios were described as: (i) typical seizure at home. (ii) typical seizure in public, (iii) atypical seizure. Respondents were recruited by a regional English ambulance service and by national public adverts. Participants were randomised to complete 2 of the 3 DCEs. RESULTS People with epilepsy (PWE; n = 427) and friends/family (n = 167) who completed the survey were representative of the target population. PWE preferred paramedics to have access to medical records, non-conveyance, to avoid lengthy episodes of care, availability of epilepsy specialists today, GP notification, and contact with epilepsy specialists within 2-3 weeks. Significant others (close family members or friends) preferred PWE experiencing an atypical seizure to be conveyed to an Urgent Treatment Centre and preferred shorter times. Optimal configuration of services from service users' perspective far out ranked current practice (rank 230/288 possible configurations). DISCUSSION Preferences differ to current practice but have minimal variation by seizure type or stakeholder. Further work on feasibility of these pathways in England, and potentially beyond, is required.
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Affiliation(s)
- Emily Holmes
- Centre for Health Economics & Medicines Evaluation, North Wales Medical School, Bangor University, UK; Department of Pharmacology and Therapeutics, University of 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, 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, UK
| | - Alison McKinlay
- Department of Basic and Clinical Neuroscience, King's College London, London, UK; Centre for Behaviour Change, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Jon Dickson
- Academic Unit of Primary Medical Care, University of Sheffield, UK
| | - Steve Goodacre
- School of Health and Related Research, University of Sheffield, UK
| | - Mike Jackson
- North West Ambulance Service NHS Trust, Bolton, UK
| | | | | | - Steve Bell
- North West Ambulance Service NHS Trust, Bolton, UK
| | - Anthony Marson
- Department of Pharmacology and Therapeutics, University of Liverpool, UK
| | - Dyfrig Hughes
- Centre for Health Economics & Medicines Evaluation, North Wales Medical School, Bangor University, UK; Department of Pharmacology and Therapeutics, University of Liverpool, UK
| | - Adam J Noble
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK.
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Delardes B, Nehme E, Bowles KA, Chakraborty S, Cox S, Smith K. Characteristics and Outcomes of Patients Referred to a General Practitioner by Victorian Paramedics. PREHOSP EMERG CARE 2024:1-10. [PMID: 38451214 DOI: 10.1080/10903127.2024.2326601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/19/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE Many patients who are attended by paramedics do not require conveyance to an emergency department (ED). Our study focuses on comparing the characteristics and outcomes of patients who were advised to follow up with a general practitioner (GP) by an attending paramedic with those of patients who were discharged at scene or transported to hospital. METHODS This was a retrospective data linkage cohort study of ambulance, ED, hospital admission, and death records for all adults attended by paramedics in Victoria, Australia between the 1st of January 2015 and 30th of June 2019. Patients were excluded if they presented in cardiac arrest, resided in a residential aged care facility, or were receiving palliative care services. Outcomes of interest included reattendance by ambulance, ED presentation; and, a high acuity outcome which we defined as a patient who (1) presented to ED and received an Australasian Triage Scale of category 1 (Resuscitation) or 2 (Emergency) AND was admitted to a ward OR (2) was admitted to an Intensive Care Unit, Coronary Care Unit or Catheter laboratory (regardless of triage category) OR (3) died. Outcomes of interest were considered within 48-h of initial EMS attendance. RESULTS A total of 1,777,950 cases were included in the study of which 3.1% were referred to a GP, 9.0% were discharged at scene without a follow-up recommendation, and 87.9% were transported to hospital. Patients referred to a GP were more likely than those discharged at scene to subsequently present to an ED within 48 h of their attendance (5.3% vs 3.8%). However, GP referral was not associated with any change to high acuity outcome (0.3% vs 0.2%) or ambulance reattendance (6.0% vs 6.0%) compared to discharge at scene. The only factors that were associated with ambulance reattendance, ED presentation, and a high acuity outcome were male gender and elevated temperature. CONCLUSIONS Despite increasing low and medium-acuity casework in this EMS system, paramedic referral to a GP is not common practice. Referring a patient to a GP did not reduce the likelihood of patients experiencing a high acuity outcome or recalling an ambulance within 48 h, suggesting opportunity exists to refine paramedic to GP referral practices.
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Affiliation(s)
- Belinda Delardes
- The Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
- Department of Paramedicine, Monash University, Frankston, Victoria, Australia
| | - Emily Nehme
- The Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Kelly-Ann Bowles
- Department of Paramedicine, Monash University, Frankston, Victoria, Australia
| | - Samantha Chakraborty
- Department of General Practice, Monash University, Melbourne, Victoria, Australia
| | - Shelley Cox
- The Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Karen Smith
- Department of Paramedicine, Monash University, Frankston, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
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Dailey MW, Hayashi W. "EMS Electronic Health Records - An Opportunity for Integration to Improve Care" Commentary on Kamta et al. PREHOSP EMERG CARE 2023; 28:513-514. [PMID: 37478004 DOI: 10.1080/10903127.2023.2234995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/23/2023]
Affiliation(s)
| | - Warren Hayashi
- Department of Emergency Medicine, Albany Medical College
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Breuer F, Beckers SK, Dahmen J, Gnirke A, Pommerenke C, Poloczek S. [Pre-emptive emergency service-Preventive missions and promotion of health literacy at the intersections with emergency medical services]. DIE ANAESTHESIOLOGIE 2023; 72:358-368. [PMID: 36912990 PMCID: PMC10010211 DOI: 10.1007/s00101-023-01272-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 03/14/2023]
Abstract
In the Emergency Medical Service Acts of the Federal States, the statements in these Acts have so far essentially been limited to the implementation of measures to maintain the health of emergency patients and to transport them to a suitable hospital. Preventive fire protection, on the other hand, is regulated in the Fire Brigade Acts or by statutory ordinances. Increasing numbers of emergency service missions and a lack of facilities for alternative care justify the need for a preventive emergency service. This includes all measures that take place before an event occurs in order to prevent emergencies from occurring. As a result, the risk of an emergency event leading to the emergency call 112 should be reduced or delayed. The preventive rescue service should also help to improve the outcome of medical care for patients. Furthermore, it should be made possible to provide those seeking help with a suitable form of care at an early stage.
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Affiliation(s)
- Florian Breuer
- Einsatzvorbereitung Rettungsdienst, Berliner Feuerwehr, Berlin, Deutschland.
- Ärztliche Leitung Rettungsdienst, Rheinisch-Bergischer Kreis, Amt für Feuerschutz und Rettungswesen, Am Rübezahlwald 7, 51469, Bergisch Gladbach, Deutschland.
| | - Stefan K Beckers
- Ärztliche Leitung Rettungsdienst Stadt Aachen, Fachbereich Feuerwehr und Rettungsdienst Stadt Aachen, Aachen, Deutschland
| | - Janosch Dahmen
- Einsatzvorbereitung Rettungsdienst, Berliner Feuerwehr, Berlin, Deutschland
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Berlin, Deutschland
- Fakultät für Gesundheit, Department Humanmedizin, Universität Witten/Herdecke, Witten, Deutschland
| | - Andre Gnirke
- Ärztliche Leitung Rettungsdienst, Rettungsdienst-Kooperation in Schleswig-Holstein, Pinneberg, Deutschland
| | | | - Stefan Poloczek
- Einsatzvorbereitung Rettungsdienst, Berliner Feuerwehr, Berlin, Deutschland
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Berlin, Deutschland
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Corcoran G, Bernard P, Kenna L, Malone A, Horgan F, O'Brien C, Ward P, Howard W, Hogan L, Mooney R, Masterson S. "Older People Want to Be in Their Own Homes": A Service Evaluation of Patient and Carer Feedback after Pathfinder Responded to Their Emergency Calls. PREHOSP EMERG CARE 2023; 27:866-874. [PMID: 36633524 DOI: 10.1080/10903127.2023.2168094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Older people experience high rates of adverse outcomes following emergency department (ED) presentation. There is growing evidence to support alternative care pathways for certain types of emergency medical services (EMS) calls. Pathfinder is one such service and targets patients aged 65 years and over, whose presenting issues can be safely managed at home by immediate paramedic, occupational therapy, and/or physiotherapy interventions. The aim of this service evaluation was to understand how older people feel about being treated at home as a result of EMS calls and to understand their experiences of the Pathfinder service. METHODS This was a thematic analysis of open-ended responses recorded from telephone interviews during routine service evaluation with service users (patients or their next-of-kin). RESULTS Of 573 service users, telephone interviews were conducted with 429 (75%). Five primary themes were identified: (1) professionalism of the multidisciplinary clinical team; (2) "the right service, in the right place, at the right time"; (3) role of Pathfinder in "getting the ball rolling"; (4) lasting effects of the experience on the patient and his or her next-of-kin; (5) value of skilled communication with the older person. CONCLUSION Older people and their next-of-kin voiced a clear preference for hospital avoidance, and strongly valued the opportunity to be treated in their homes at the time of an EMS call rather than default conveyance to the ED. They appreciated the importance of a skilled multidisciplinary team with a follow-up service that effectively positions itself between the acute hospital and community services.
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Affiliation(s)
- Grace Corcoran
- Physiotherapy Department, Beaumont Hospital, Dublin, Ireland
| | - Paul Bernard
- Occupational Therapy Department, Beaumont Hospital, Dublin, Ireland
| | - Lawrence Kenna
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Ailish Malone
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Claire O'Brien
- Occupational Therapy Department, Beaumont Hospital, Dublin, Ireland
| | - Peter Ward
- Physiotherapy Department, Beaumont Hospital, Dublin, Ireland
| | - Willie Howard
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Laura Hogan
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Rebecca Mooney
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Siobhan Masterson
- National Ambulance Service, Health Service Executive, Dublin, Ireland
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Ridyard C, Smith M, Spaight R, Law GR, Siriwardena AN. Optimising ambulance conveyance rates and staff costs by adjusting proportions of rapid-response vehicles and dual-crewed ambulances: an economic decision analytical modelling study. J Accid Emerg Med 2023; 40:56-60. [PMID: 36357167 DOI: 10.1136/emermed-2021-212209] [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: 11/30/2021] [Accepted: 10/28/2022] [Indexed: 11/12/2022]
Abstract
AIM To model optimum proportions of dual-crewed ambulances (DCAs) and rapid-response vehicles (RRVs) in Ambulance Trusts with a view to generating a policy brief for one Ambulance Trust and a modelling tool for other Trusts on the strategic procurement and allocation of emergency vehicle (EV) resources. METHODS Historical EV assignments for 12 months of emergency calls in 2019 were provided by an NHS Ambulance Trust and analysed for backup, see and treat, and patient to hospital conveyance. Unit costs were derived for paramedics and technicians using Agenda for Change pay rates. Time cycles were assigned for RRV and DCA attendances and unit costs assigned to these. Information was put into a decision analytical model to estimate the costs and numbers of vehicles attending incidents based on relative proportions of available RRVs and DCAs. RESULTS Of 711 992 calls attended by 837 107 EVs, 514 766 (72.3%) required at least one emergency department conveyance. The rate of conveyance was significantly lower when RRVs arrived first on the scene. 27 883 out of 529 693 (5.3%) DCAs first arriving at an incident required some backup, and this was also factored into the model. Modelling demonstrated high conveyance rates were counterproductive when increasing the relative proportions of RRVs to DCAs. For example, with conveyance rates of 65%, increasing the RRVs increased the cost and numbers of vehicles attending per incident. At lower conveyance rates, however, there was a levelling around 30% where it could become cost-effective to increase the relative proportions of RRVs to DCAs. CONCLUSION At current overall conveyance rates, there is no benefit in increasing the relative proportions of RRVs to DCAs unless additional benefits can be realised that bring the conveyance rates down.
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Affiliation(s)
- Colin Ridyard
- Community and Health Research Unit, University of Lincoln, Lincoln, UK
| | - Murray Smith
- Community and Health Research Unit, University of Lincoln, Lincoln, UK
| | - Robert Spaight
- Clnical Audit and Research Unit, East Midlands Ambulance Service NHS Trust, Nottingham, UK
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Nehme E, Nehme Z, Cox S, Smith K. Outcomes of paediatric patients who are not transported to hospital by Emergency Medical Services: a data linkage study. J Accid Emerg Med 2023; 40:12-19. [PMID: 36202623 DOI: 10.1136/emermed-2022-212350] [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: 01/24/2022] [Accepted: 09/24/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Data on the safety of non-transport decisions for paediatric patients attended by Emergency Medical Services (EMS) are lacking. We describe the characteristics and outcomes of paediatric non-transported patients in Victoria, Australia. METHODS A retrospective data linkage study of consecutive paediatric (aged <18 years) non-transported patients between January 2015 and June 2019. Patients were linked to ED, hospital admission and death records. Multivariable logistic regression analyses were used to determine factors associated with EMS recontact, ED presentation, hospital admission and an adverse event (death/cardiac arrest, intensive care unit admission or highest ED triage category) within 48 hours of the initial emergency call. RESULTS In total, 62 975 non-transported patients were included. The mean age was 7.1 (SD 6.0) years and 48.9% were male. Overall, 2.2% recontacted the EMS within 48 hours, 13.7% self-presented to a public ED, 2.4% were admitted to hospital and 0.1% had an adverse event, including two deaths. Among patients with paramedic-initiated non-transport (excluding transport refusals and transport via other means), 5.6% presented to a public ED, 1.1% were admitted to hospital and 0.05% had an adverse event. In the overall population, an abnormal vital sign on initial assessment increased the odds of hospital admission and an adverse event. Among paramedic-initiated non-transports, cases occurring in the early hours of the morning (04:00-08:00 hours) were associated with increased odds of subsequent hospital admission, while the odds of ED presentation and hospital admission also increased with increasing prior exposure to non-transported cases. CONCLUSION Adverse events were rare among paramedic-initiated non-transport cases. Vital sign derangements and attendance by paramedics with higher prior exposure to non-transports were associated with poorer outcomes and may be used to improve safety.
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Affiliation(s)
- Emily Nehme
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia .,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Ziad Nehme
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia.,Department of Paramedicine, Monash University, Clayton, Victoria, Australia
| | - Shelley Cox
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Karen Smith
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia.,Department of Paramedicine, Monash University, Clayton, Victoria, Australia
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Noble AJ, Mason SM, Bonnett LJ, Reuber M, Wright J, Pilbery R, Jacques RM, Simpson RM, Campbell R, Fuller A, Marson AG, Dickson JM. Supporting the ambulance service to safely convey fewer patients to hospital by developing a risk prediction tool: Risk of Adverse Outcomes after a Suspected Seizure (RADOSS)-protocol for the mixed-methods observational RADOSS project. BMJ Open 2022; 12:e069156. [PMID: 36375988 PMCID: PMC9668054 DOI: 10.1136/bmjopen-2022-069156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Ambulances services are asked to further reduce avoidable conveyances to emergency departments (EDs). Risk of Adverse Outcomes after a Suspected Seizure seeks to support this by: (1) clarifying the risks of conveyance and non-conveyance, and (2) developing a risk prediction tool for clinicians to use 'on scene' to estimate the benefits an individual would receive if conveyed to ED and risks if not. METHODS AND ANALYSIS Mixed-methods, multi-work package (WP) project. For WP1 and WP2 we shall use an existing linked data set that tracks urgent and emergency care (UEC) use of persons served by one English regional ambulance service. Risk tools are specific to clinical scenarios. We shall use suspected seizures in adults as an exemplar.WP1: Form a cohort of patients cared for a seizure by the service during 2019/2020. It, and nested Knowledge Exchange workshops with clinicians and service users, will allow us to: determine the proportions following conveyance and non-conveyance that die and/or recontact UEC system within 3 (/30) days; quantify the proportion of conveyed incidents resulting in 'avoidable ED attendances' (AA); optimise risk tool development; and develop statistical models that, using information available 'on scene', predict the risk of death/recontact with the UEC system within 3 (/30) days and the likelihood of an attendance at ED resulting in an AA.WP2: Form a cohort of patients cared for a seizure during 2021/2022 to 'temporally' validate the WP1 predictive models.WP3: Complete the 'next steps' workshops with stakeholders. Using nominal group techniques, finalise plans to develop the risk tool for clinical use and its evaluation. ETHICS AND DISSEMINATION WP1a and WP2 will be conducted under database ethical approval (IRAS 307353) and Confidentiality Advisory Group (22/CAG/0019) approval. WP1b and WP3 have approval from the University of Liverpool Central Research Ethics Committee (11450). We shall engage in proactive dissemination and knowledge mobilisation to share findings with stakeholders and maximise evidence usage.
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Affiliation(s)
- Adam J Noble
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Suzanne M Mason
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Laura J Bonnett
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Markus Reuber
- Academic Neurology Unit, The University of Sheffield, Sheffield, UK
| | | | - Richard Pilbery
- Research and Development Department, Yorkshire Ambulance Service NHS Trust, Wakefield, UK
| | - Richard M Jacques
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Rebecca M Simpson
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Richard Campbell
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | | | - Anthony Guy Marson
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Jon Mark Dickson
- Academic Unit of Primary Medical Care, The University of Sheffield, Sheffield, UK
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Bunting D, Endo T, Watt K, Daniel R, Bosley E. Mastering Linked Datasets: The Future of Emergency Health Care Research. PREHOSP EMERG CARE 2022; 27:1031-1040. [PMID: 35913099 DOI: 10.1080/10903127.2022.2108179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/21/2022] [Indexed: 10/16/2022]
Abstract
Objectives: The aim of this work is to describe routine integration of prehospital emergency health records into a health master linkage file, delivering ongoing access to integrated patient treatment and outcome information for ambulance-attended patients in Queensland.Methods: The Queensland Ambulance Service (QAS) data are integrated monthly into the Queensland Health Master Linkage File (MLF) using a linkage algorithm that relies on probabilistic matches in combination with deterministic rules based on patient demographic details, date, time and facility identifiers. Each ambulance record is assigned an enduring linkage key (unique patient identifier) and further processing determines whether each record matches with a corresponding hospital emergency department, admission or death registry record. In this study, all QAS electronic ambulance report form (eARF) records from October 2016 to December 2018 where at least 1 key linkage variable was present (n = 1,771,734) were integrated into the MLF.Results: The majority of records (n = 1,456,502; 82.2%) were for transported patients, and 90.1% (n = 1,312,176) of these transports were to public hospital facilities. Of these transport records, 93.9% (n = 1,231,951) matched to emergency department (ED) records and 59.3% (n = 864,394) also linked to admitted patient records. Of ambulance non-transport records integrated into the MLF, 23.6% (n = 74,311) matched with ED records.Conclusion: This study demonstrates robust linkage methods, quality assurance processes and high linkage rates of data across the continuum of care (prehospital/emergency department/admitted patient/death) in Queensland. The resulting infrastructure provides a high-quality linked dataset that facilitates complex research and analysis to inform critical functions such as quality improvement, system evaluation and design.
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Affiliation(s)
- Denise Bunting
- Information Support, Research & Evaluation, Queensland Ambulance Service, Brisbane, Australia
| | - Taku Endo
- Queensland Health, Preventive Health Branch, Brisbane, Australia
| | - Kerrianne Watt
- Information Support, Research & Evaluation, Queensland Ambulance Service, Brisbane, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Raymond Daniel
- Queensland Health, Statistical Services Branch, Brisbane, Australia
| | - Emma Bosley
- Information Support, Research & Evaluation, Queensland Ambulance Service, Brisbane, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
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Outcomes in patients not conveyed by emergency medical services (EMS): a one-year prospective study. Scand J Trauma Resusc Emerg Med 2022; 30:40. [PMID: 35698086 PMCID: PMC9195370 DOI: 10.1186/s13049-022-01023-3] [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: 12/06/2021] [Accepted: 05/09/2022] [Indexed: 12/05/2022] Open
Abstract
Background The decision to not convey patients has become common in emergency medical services worldwide. A substantial proportion (12–51%) of the patients seen by emergency medical services are not conveyed by those services. The practice of non-conveyance is a result of the increasing and changing demands on the acute care system. Research focusing on the outcomes of the decision by emergency medical services to not convey patients is needed. Aim The aim was to describe outcomes (emergency department visits, admission to in-hospital intensive care units and mortality, all within seven days) and their association with the variables (sex, age, day of week, time of day, emergency signs and symptoms codes, triage level colour, and destination) for non-conveyed patients. Methods This was a prospective analytical study with consecutive inclusion of all patients not conveyed by emergency medical services. Patients were included between February 2016 and January 2017. The study was conducted in Region Örebro county, Sweden. The region consists of both rural and urban areas and has a population of approximately 295,000. The region had three ambulance departments that received approximately 30,000 assignments per year. Results The result showed that no patient received intensive care, and 18 (0.7%) patients died within seven days after the non-conveyance decision. Older age was associated with a higher risk of hospitalisation and death within seven days after a non-conveyance decision. Conclusions Based on the results of this one-year follow-up study, few patients compared to previous studies were admitted to the hospital, received intensive care or died within seven days. This study contributes insights that can be used to improve non-conveyance guidelines and minimise the risk of patient harm. Supplementary information The online version contains supplementary material available at 10.1186/s13049-022-01023-3.
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Glober N, Hamilton J, Montelauro N, Ulintz A, Arkins T, Supples M, Liao M, O'Donnell D, Faris G. Safety of an Alternative Care Protocol for EMS non-transport in the COVID-19 Pandemic. PREHOSP EMERG CARE 2022; 27:315-320. [PMID: 35666266 DOI: 10.1080/10903127.2022.2086652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM Our primary goal was to evaluate safety of a new emergency medical services (EMS) protocol directing non-transport of low-acuity patients during the COVID-19 pandemic. METHODS We performed a retrospective cohort analysis of all patients in Marion County, Indiana, from March 23, 2020 to May 25, 2020 for whom a novel non-transport protocol was used by EMS for patients with low-acuity COVID-19 symptoms. We assessed paramedic compliance with the protocol to determine numbers and types of deviations. We further reviewed a statewide health information exchange database to identify any patients with emergency department (ED) visits, hospital admissions, or death within 30 days of the EMS non-transport. For ED and hospital visits, we collected ED or admission diagnoses to determine if the etiologies were COVID-related. RESULTS Between March 24, 2020 and May 25, 2020, 222 patients were documented as "Treated, Released (per protocol)." The protocol was correctly applied 144 times (64.8%). The other 78 times, although the EMS clinicians documented use of the protocol, it was not actually used (e.g., another protocol such as "no medical emergency" was used). Of the 144 patients for whom the protocol was used, in 55 cases (38.2%), the clinicians documented patient factors that should have contraindicated use of the protocol (e.g., chest pain, past medical history of asthma). The protocol was applied 5 times (3.5%) in pediatric patients. Two patients were admitted to the hospital within 72 hours of incorrect application of the protocol; both were for COVID-related complaints. Two patients were admitted to the hospital within 72 hours of correct protocol use; one was for a COVID-related complaint. CONCLUSION In this case series, paramedics demonstrated large deviations from the novel non-transport protocol. Several patients were admitted to the hospital within 72 hours of non-transport both when the protocol was used correctly, and when it was used incorrectly.
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Affiliation(s)
- Nancy Glober
- Department of Emergency Medicine, Indiana University, Indianapolis, USA
| | | | | | - Alex Ulintz
- Department of Emergency Medicine, Indiana University, Indianapolis, USA
| | - Thomas Arkins
- Indianapolis Emergency Medical Services, Indianapolis, USA
| | - Michael Supples
- Department of Emergency Medicine, Indiana University, Indianapolis, USA
| | - Mark Liao
- Department of Emergency Medicine, Indiana University, Indianapolis, USA
| | - Daniel O'Donnell
- Department of Emergency Medicine, Indiana University, Indianapolis, USA
| | - Greg Faris
- Department of Emergency Medicine, Indiana University, Indianapolis, USA
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Heinonen K, Puolakka T, Salmi H, Boyd J, Laiho M, Porthan K, Harve‐Rytsälä H, Kuisma M. Ambulance crew-initiated non-conveyance in the Helsinki EMS system-A retrospective cohort study. Acta Anaesthesiol Scand 2022; 66:625-633. [PMID: 35170028 PMCID: PMC9544076 DOI: 10.1111/aas.14049] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 01/23/2022] [Accepted: 02/06/2022] [Indexed: 11/30/2022]
Abstract
Background Ambulance patients are usually transported to the hospital in the emergency medical service (EMS) system. The aim of this study was to describe the non‐conveyance practice in the Helsinki EMS system and to report mortality following non‐conveyance decisions. Methods All prehospital patients ≥16 years attended by the EMS but not transported to a hospital during 2013–2017 were included in the study. EMS mission‐ and patient‐related factors were collected and examined in relation to patient death within 30 days of the EMS non‐conveyance decision. Results The EMS performed 324,207 missions with a patient during the study period. The patient was not transported in 95,909 (29.6%) missions; 72,233 missions met the study criteria. The patient mean age (standard deviation) was 59.5 (22.5) years; 55.5% of patients were female. The most common dispatch codes were malaise (15.0%), suspected decline in vital signs (14.0%), and falling over (12.9%). A total of 960 (1.3%) patients died within 30 days after the non‐conveyance decision. Multivariate logistic regression analysis revealed that mortality was associated with the patient's inability to walk (odds ratio 3.19, 95% confidence interval 2.67–3.80), ambulance dispatch due to shortness of breath (2.73, 2.27–3.27), decreased level of consciousness (2.72, 1.75–4.10), decreased blood oxygen saturation (2.64, 2.27–3.06), and abnormal systolic blood pressure (2.48, 1.79–3.37). Conclusion One‐third of EMS missions did not result in patient transport to the hospital. Thirty‐day mortality was 1.3%. Abnormalities in multiple respiratory‐related vital signs were associated with an increased likelihood of death within 30 days.
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Affiliation(s)
- Kari Heinonen
- Department of Emergency Medicine & Services Helsinki University Hospital and University of Helsinki Helsinki Finland
- Department of Anesthesiology & Intensive Care Medicine Helsinki University Hospital and University of Helsinki Helsinki Finland
| | - Tuukka Puolakka
- Department of Emergency Medicine & Services Helsinki University Hospital and University of Helsinki Helsinki Finland
- Department of Anesthesiology & Intensive Care Medicine Helsinki University Hospital and University of Helsinki Helsinki Finland
| | - Heli Salmi
- Department of Anesthesiology & Intensive Care Medicine Helsinki University Hospital and University of Helsinki Helsinki Finland
| | - James Boyd
- Department of Emergency Medicine & Services Helsinki University Hospital and University of Helsinki Helsinki Finland
| | - Mia Laiho
- Parliament of Finland Helsinki Finland
| | - Kari Porthan
- Helsinki City Rescue Department Helsinki Finland
| | - Heini Harve‐Rytsälä
- Department of Emergency Medicine & Services Helsinki University Hospital and University of Helsinki Helsinki Finland
| | - Markku Kuisma
- Department of Emergency Medicine & Services Helsinki University Hospital and University of Helsinki Helsinki Finland
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Andrew E, Cox S, Smith K. Linking Ambulance Records with Hospital and Death Index Data to Evaluate Patient Outcomes. Int J Gen Med 2022; 15:567-572. [PMID: 35046714 PMCID: PMC8763257 DOI: 10.2147/ijgm.s328149] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/15/2021] [Indexed: 12/02/2022] Open
Abstract
Objective Linkage of electronic administrative datasets is becoming increasingly common, offering a powerful resource for research and analysis. However, routine linkage of prehospital data with emergency department (ED) presentation and hospital admission datasets is rare. We describe a methodology used to link ambulance data with hospital ED presentations, admissions, and death records, and examine potential biases between matched and unmatched patients. Methods Iterative deterministic linkage methodologies were employed to link clinical, operational, and secondary triage ambulance data to ED presentations, hospital admissions, and death records in Victoria, Australia. Descriptive analyses and standardised differences were used to examine potential biases between matched and unmatched patients. Results A total of 2,813,913 ambulance records were available for linkage. Of the patients that were transported to a public ED (n=1,753,268), 83.3% matched with an ED record. Only small differences were observed between matched and unmatched patients for sex, year, time of day and attending crew type. The data elements with the largest standardised differences were patient age (0.25) and paramedic diagnosis (0.25). Matched patients were older (mean ± standard deviation: 55.6±25.7 vs 49.0±26.0 years) and more likely to have a paramedic-suspected cardiac, respiratory, neurological, or gastrointestinal/genitourinary condition, suspected infection/sepsis, or pain. Conclusion This linked dataset will facilitate a large body of research into prehospital care and patient outcomes. Although future analysis of matched patients should acknowledge the linkage error rate, our findings suggest that results are likely to be generalisable to the broader ambulance population.
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Affiliation(s)
- Emily Andrew
- Centre for Research and Evaluation, Ambulance Victoria, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
- Correspondence: Emily Andrew Email
| | - Shelley Cox
- Centre for Research and Evaluation, Ambulance Victoria, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Karen Smith
- Centre for Research and Evaluation, Ambulance Victoria, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
- Department of Paramedicine, Monash University, Victoria, Australia
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Paulin J, Kurola J, Koivisto M, Iirola T. EMS non-conveyance: A safe practice to decrease ED crowding or a threat to patient safety? BMC Emerg Med 2021; 21:115. [PMID: 34627138 PMCID: PMC8502399 DOI: 10.1186/s12873-021-00508-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/27/2021] [Indexed: 12/31/2022] Open
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.
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Affiliation(s)
- Jani Paulin
- Department of Clinical Medicine, University of Turku and Turku University of Applied Sciences, Turku, Finland.
| | - Jouni Kurola
- Centre for Prehospital Emergency Care, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Mari Koivisto
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Timo Iirola
- Emergency Medical Services, Turku University Hospital and University of Turku, Turku, Finland
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Mackenhauer J, Valentin JB, Mikkelsen S, Steinmetz J, Væggemose U, Christensen HC, Mainz J, Johnsen SP, Christensen EF. Emergency Medical Services response levels and subsequent emergency contacts among patients with a history of mental illness in Denmark: a nationwide study. Eur J Emerg Med 2021; 28:363-372. [PMID: 33709996 DOI: 10.1097/mej.0000000000000806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND IMPORTANCE People with mental illness have higher use of emergency services than the general population and may experience problems with navigating in complex healthcare systems. Poor physical health contributes to the excess mortality among the mentally ill. OBJECTIVE To compare the level of Emergency Medical Services (EMS) response and subsequent contacts emergency between patients with and without a history of mental illness. DESIGN, SETTING, AND PARTICIPANTS A nationwide cohort study was conducted in Denmark including medical 1-1-2 calls 2016 2017. The healthcare system is financed through taxation allowing free access to healthcare services including ambulance services. EXPOSURE Exposed groups had a history of major, moderate, or minor mental illness. OUTCOME MEASURES AND ANALYSIS We studied seven national prehospital care Performance Indicators (PI 1-7). The selected PI concerned EMS response levels and subsequent contacts to prehospital and in-hospital services. Exposed groups were compared to nonexposed groups using regression analyses. RESULTS We included 492 388 medical 1-1-2 calls: 8, 10, and 18% of calls concerned patients with a history of major, moderate, or minor mental illness, respectively.There were no clinically relevant differences regarding response times (PI 1-2) or registration of symptoms (PI 3) between groups.If only telephone advice was offered, patients with a history of major, moderate or minor mental illness were more likely to recall within 24 h (PI 4): adjusted risk ratio (RR) 2.11 (1.88-2.40), 1.96 (1.20-2.21), and 1.38 (1.20-1.60), but less or equally likely to have an unplanned hospital contact within 7 days (PI 6): adjusted RRs 1.05 (0.99-1.12), 1.04 (0.99-1.10), and 0.90 (0.85-0.94), respectively.If released at the scene, the risk of recalling (PI 5) or having an unplanned hospital contact (PI 7) was higher among patients with a history of mental illness: adjusted RRs 2.86 (2.44-3.36), 2.41 (2.05-2.83), and 1.57 (1.35-1.84), and adjusted RRs 2.10 (1.94-2.28), 1.68 (1.55-1.81), and 1.25 (1.17-1.33), respectively.Patients with a history of mental illness were more likely to receive telephone advice only adjusted RRs 1.61 (1.53-1.70), 1.30 (1.24-1.37), and 1.08 (1.04-1.13), and being released at scene adjusted RRs 1.11 (1.08-1.13), 1.03 (1.01-1.04), and 1.05 (1.03-1.07). CONCLUSION More than one-third of the study population had a history of mental illness. These patients received a significantly lighter EMS response than patients with no history of mental illness. They were significantly more likely to use the emergency care system again if released at scene. This risk increased with the increasing severity of the mental illness.
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Affiliation(s)
- Julie Mackenhauer
- Department of Clinical Medicine, Danish Center for Clinical Health Services Research (DACS), Mølleparkvej 10, Aalborg University
- Psychiatry, Aalborg University Hospital, Mølleparkvej 10, North Denmark Region, Aalborg
| | - Jan Brink Valentin
- Department of Clinical Medicine, Danish Center for Clinical Health Services Research (DACS), Mølleparkvej 10, Aalborg University
| | - Søren Mikkelsen
- The Prehospital Research Unit, Region of Southern Denmark, University of Southern Denmark Odense
| | | | - Ulla Væggemose
- Research and Development, Prehospital Emergency Medical Services, Central Denmark Region
- Department of Clinical Medicine, Aarhus University
| | | | - Jan Mainz
- Department of Clinical Medicine, Danish Center for Clinical Health Services Research (DACS), Mølleparkvej 10, Aalborg University
- Psychiatry, Aalborg University Hospital, Mølleparkvej 10, North Denmark Region, Aalborg
- Department for Community Mental Health, Haifa University, Haifa, Israel
- Department of Health Economics, University of Southern Denmark, Odense
| | - Søren Paaske Johnsen
- Department of Clinical Medicine, Danish Center for Clinical Health Services Research (DACS), Mølleparkvej 10, Aalborg University
| | - Erika Frischknecht Christensen
- Department of Clinical Medicine, Centre for Prehospital and Emergency Research, Aalborg University
- Centre for Prehospital and Emergency Research, Internal and Emergency Medicine Clinic, Aalborg University Hospital, Aalborg
- Prehospital Emergency Medical Services, North Denmark Region, Denmark
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Vicente V, Johansson A, Selling M, Johansson J, Möller S, Todorova L. Experience of using video support by prehospital emergency care physician in ambulance care - an interview study with prehospital emergency nurses in Sweden. BMC Emerg Med 2021; 21:44. [PMID: 33827436 PMCID: PMC8028766 DOI: 10.1186/s12873-021-00435-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/12/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction When in need of emergency care and ambulance services, the ambulance nurse is often the first point of contact for the patient with healthcare. This role requires comprehensive knowledge of the ambulance nurse to be able to assign the right level of care and, if necessary, to provide self-care advice for patients with no further conveyance to hospital. Recently, an application was developed for transmitting real-time video to facilitate consultation between ambulance nurses and prehospital physicians in the role of regional medical support (RMS) for ambulance care. The use of video communication as a complement of medical support when referring to self-care is still an unexplored method in a prehospital setting. Our study aimed to elucidate ambulance nurses’ experience of video consultation with RMS physician during the assessment of patients considered to be triaged to self-care. Method We conducted a qualitative design study using semi-structured interviews with open questions. Twelve ambulance nurses were included in the study. To explore the ambulance nurses’ experience of performing video consultation with RMS physician, in cases when a patient was assessed and triaged to self-care, a content analysis was performed. Results A main category emerged from the results: “ Video consultation as decision support in the ambulance care promotes increased patient participation and for the ambulance nurses, it creates a feeling of increased patient safety “. The main category was based and formed on the following categories: “ Simultaneous presence of ambulance nurse and a physician increases patient participation during the assessment resulting in a confident care decision “. “Interprofessional collaboration strengthens the medical assessment”. “Video technology promotes accessibility for patients needs in the ambulance care regardless of emergency level”. Conclusions Ambulance nurses experienced that the use of video consultation increases patient involvement and confidence in healthcare when both the ambulance nurse and the physician were present when deciding on self-care advice. The live imaging allowed the ambulance nurse and prehospital physician to reach a consensus on the patient’s current medical care needs, which in turn led to a feeling of increased patient safety for the ambulance nurses.
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Affiliation(s)
- Veronica Vicente
- The Ambulance Medical Service in Stockholm (AISAB), Lindetorpsvägen 11, SE-121 18 Johanneshov, Stockholm, Sweden. .,Academic EMS, Stockholm, Sweden. .,Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset in Stockholm, Stockholm, Sweden.
| | - Anders Johansson
- Office of Medical Services, Region Skåne, Malmö, Sweden.,Department of Clinical Science, Lund University, Region Skåne, Lund, Sweden
| | - Magnus Selling
- Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset in Stockholm, Stockholm, Sweden
| | - Johnny Johansson
- Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset in Stockholm, Stockholm, Sweden
| | - Sebastian Möller
- Office of Medical Services, Region Skåne, Malmö, Sweden.,Department of Clinical Science, Lund University, Region Skåne, Lund, Sweden
| | - Lizbet Todorova
- Office of Medical Services, Region Skåne, Malmö, Sweden.,Department of Clinical Science, Lund University, Region Skåne, Lund, Sweden
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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] [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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Günther A, Swart E, Schmid S. Rettungsdiensteinsätze am Lebensende: erste Ergebnisse eines sektorenübergreifenden Rückmelde- und Kontrollsystems. DER NOTARZT 2021. [DOI: 10.1055/a-1373-3791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Zusammenfassung
Hintergrund Informationen über den Verlauf von Rettungsdienstpatienten kann für Fortbildung und Strukturverbesserung nützlich sein.
Patienten/Material und Methoden Eine systematische Verlinkung von Sterberegister- und Rettungsdienstdaten identifiziert Sterbefälle nach ambulantem Kontakt mit dem Rettungsdienst ohne notärztliche Beteiligung (AKRD) und bietet Anlass für individuelle Einsatznachbesprechungen.
Ergebnisse In den Jahren 2018 und 2019 erfolgten in der Stadt Braunschweig 115 409 Rettungsdiensteinsätze. Es verstarben 7185 Menschen, ihr Alter betrug im Median 78 (0 – 106) Jahre (Min – Max), 3585 (49,9%) waren weiblich. Am Sterbetag oder am Vortag des Todes erfolgten 1003 Einsätze. Diese Patienten waren 78 (0 – 101) Jahre alt, 468 (46,7%) waren weiblich. Dabei wurden 8 AKRD identifiziert. Diese Patienten waren 73 (30 – 90) Jahre alt, 2 waren weiblich.
Schlussfolgerung Sterbefälle nach AKRD waren ähnlich häufig wie international publiziert. Das System bietet verschiedene Nutzungs- und Entwicklungsmöglichkeiten.
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Affiliation(s)
| | - Enno Swart
- Institut für Sozialmedizin und Gesundheitssystemforschung, Otto-von-Guericke-Universität Magdeburg Medizinische Fakultät, Deutschland
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Todd VF, Swain A, Howie G, Tunnage B, Smith T, Dicker B. Factors Associated with Emergency Medical Service Reattendance in Low Acuity Patients Not Transported by Ambulance. PREHOSP EMERG CARE 2021:1-17. [PMID: 33320722 DOI: 10.1080/10903127.2020.1862943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 12/03/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
Background: The decision for emergency medical services (EMS) personnel not to transport a patient is challenging: there is a risk of subsequent deterioration but transportation of all patients to hospital would overburden emergency departments. The aim of this large-scale EMS study was to identify factors associated with an increased likelihood of ambulance reattendance within 48 hours in low acuity patients who were not transported by ambulance.Methods: We conducted a 2-year retrospective cohort study using data from the St John New Zealand EMS between 1 July 2016 and 30 June 2018 to investigate demographic and clinical associations with ambulance reattendance.Results: In total, 83,171 low acuity patients not transported by ambulance were included, of whom 4,512 (5.4%) had an EMS ambulance reattend within 48 hours. There were significant associations between EMS reattendance and patient age, sex, ethnicity, deprivation, and event location. Patients aged 60-74 years old had the highest likelihood of ambulance recall (OR 2.87, 95% CI: 2.51-3.28). Males were more likely to have an EMS ambulance reattend within 48 hours (OR 1.17, 95% CI: 1.09-1.25). Māori and Pacific Peoples had a similar likelihood of EMS recall to European/Others; however, the Asian cohort showed a reduced likelihood of reattendance (OR 0.76, 95% CI: 0.62-0.93).There were significant associations between EMS reattendance and non-transport reason, time spent on scene, event type, clinical acuity level (status), and pain score. Shorter (<30 minutes) on scene times were associated with a decreased likelihood of ambulance reattendance, whereas longer scene times (>45 minutes) were associated with an increased likelihood. Medical events were more likely to require reattendance than accident-related events (OR 1.22, 95% CI: 1.13-1.32). Non-transported patients with a severe pain score (7-10/10) were at increased likelihood of requiring reattendance (OR 1.60, 95% CI: 1.33-1.92).Discussion: The overall low rate of EMS reattendance is encouraging. Further research is needed into the clinical presentation of patients requiring ambulance reattendance within 48 hours to determine if there are early warning signs indicative of subsequent deterioration.
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Affiliation(s)
- Verity F Todd
- Received November 25, 2019 from Clinical Audit and Research Team, St John New Zealand, Auckland, New Zealand (VFT, GH, BT, TS, BD); Paramedicine Department, Auckland University of Technology, Auckland, New Zealand (VFT, AS, GH, BT, BD); Wellington Free Ambulance, Wellington, New Zealand (AS). Revision received December 3, 2020; accepted for publication December 6, 2020
| | - Andy Swain
- Received November 25, 2019 from Clinical Audit and Research Team, St John New Zealand, Auckland, New Zealand (VFT, GH, BT, TS, BD); Paramedicine Department, Auckland University of Technology, Auckland, New Zealand (VFT, AS, GH, BT, BD); Wellington Free Ambulance, Wellington, New Zealand (AS). Revision received December 3, 2020; accepted for publication December 6, 2020
| | - Graham Howie
- Received November 25, 2019 from Clinical Audit and Research Team, St John New Zealand, Auckland, New Zealand (VFT, GH, BT, TS, BD); Paramedicine Department, Auckland University of Technology, Auckland, New Zealand (VFT, AS, GH, BT, BD); Wellington Free Ambulance, Wellington, New Zealand (AS). Revision received December 3, 2020; accepted for publication December 6, 2020
| | - Bronwyn Tunnage
- Received November 25, 2019 from Clinical Audit and Research Team, St John New Zealand, Auckland, New Zealand (VFT, GH, BT, TS, BD); Paramedicine Department, Auckland University of Technology, Auckland, New Zealand (VFT, AS, GH, BT, BD); Wellington Free Ambulance, Wellington, New Zealand (AS). Revision received December 3, 2020; accepted for publication December 6, 2020
| | - Tony Smith
- Received November 25, 2019 from Clinical Audit and Research Team, St John New Zealand, Auckland, New Zealand (VFT, GH, BT, TS, BD); Paramedicine Department, Auckland University of Technology, Auckland, New Zealand (VFT, AS, GH, BT, BD); Wellington Free Ambulance, Wellington, New Zealand (AS). Revision received December 3, 2020; accepted for publication December 6, 2020
| | - Bridget Dicker
- Received November 25, 2019 from Clinical Audit and Research Team, St John New Zealand, Auckland, New Zealand (VFT, GH, BT, TS, BD); Paramedicine Department, Auckland University of Technology, Auckland, New Zealand (VFT, AS, GH, BT, BD); Wellington Free Ambulance, Wellington, New Zealand (AS). Revision received December 3, 2020; accepted for publication December 6, 2020
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21
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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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22
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Alrazeeni DM. Relationship Between Nonconveyed Cases and On-Scene Time Intervals for Emergency Medical Services. J Multidiscip Healthc 2020; 13:1895-1904. [PMID: 33324069 PMCID: PMC7733405 DOI: 10.2147/jmdh.s279693] [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: 09/21/2020] [Accepted: 11/15/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Emergency medical service (EMS) consumption is increasing worldwide. Some EMS cases in Saudi Arabia result in nonconveyance of patients. The aim of the present study was to determine the relationship between nonconveyed EMS cases and on-scene time intervals in Riyadh EMS centers. Methods Nonrandomized retrospective data obtained from EMS providers of nonconveyed emergency cases were gathered and analyzed. Data were taken from the ten busiest EMS centers in Riyadh, Saudi Arabia from January 1 to April 30, 2019. Analyses of means ± SD, bivariate comparisons, multivariate analysis, CI correlations, and regressionwere performed. Results Categories of nonconveyed cases were “Treatment given at the scene” V1 = 66, “Refused by patient/relative” (V2 = 876), “Patient not found” (V3 = 67), “Dead patient” (V4 = 80”, “Other (police, etc)” (V5 = 34), and NA (96). We found highly significant differences (p<0.001) among several categories of nonconveyed cases and on-scene time intervals among EMS centers. Conclusion This study found that there were highly significant differences among several categories of nonconveyed cases in relation to on-scene time intervals for different EMS centers. Results indicated that the probability of nonconveyance decisions was more likely to increase in the categories “Refused by patient/relative,” “Patient not found,” and “Dead patient.” The results did not reveal details of what happened on scene during or after the nonconveyance decision had been made, which needs to be investigated.
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Affiliation(s)
- Daifallah M Alrazeeni
- Academic Affairs, Prince Sultan Bin Abdulaziz College for EMS, King Saud University, Riyadh, Saudi Arabia
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23
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Clark SJ, Halter M, Porter A, Smith HC, Brand M, Fothergill R, Lindridge SJ, McTigue M, Snooks H. Using deterministic record linkage to link ambulance and emergency department data: is it possible without patient identifiers? A case study from the UK. Int J Popul Data Sci 2019; 4:1104. [PMID: 34095533 PMCID: PMC8142959 DOI: 10.23889/ijpds.v4i1.1104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Routine linkage of emergency ambulance records with those from the emergency department is uncommon in the UK. Our study, known as the Pre-Hospital Emergency Department Data Linking Project (PHED Data), aimed to link records of all patients conveyed by a single emergency ambulance service to thirteen emergency departments in the UK from 2012-2016. OBJECTIVES We aimed to examine the feasibility and resource requirements of collecting de-identified emergency department patient record data and, using a deterministic matching algorithm, linking it to ambulance service data. METHODS We used a learning log to record contacts and activities undertaken by the research team to achieve data linkage. We also conducted semi-structured interviews with information management/governance staff involved in the process. RESULTS We found that five steps were required for successful data linkage for each hospital trust. The total time taken to achieve linkage was a mean of 65 weeks. A total of 958,057 emergency department records were obtained and, of these, 81% were linked to a corresponding ambulance record. The match rate varied between hospital trusts (50%-94%). Staff expressed strong enthusiasm for data linkage. Barriers to successful linkage were mainly due to inconsistencies between and within acute trusts in the recording of two ambulance event identifiers (CAD and call sign). Further data cleaning was required on emergency department fields before full analysis could be conducted. Ensuring the data was not re-identifiable limited validation of the matching method. CONCLUSION We conclude that deterministic record linkage based on the combination of two event identifiers (CAD and call sign) is possible. There is an appetite for data linkage in healthcare organisations but it is a slow process. Developments in standardising the recording of emergency department data are likely to improve the quality of the resultant linked dataset. This would further increase its value for providing evidence to support improvements in health care delivery. HIGHLIGHTS Ambulance records are rarely linked to other datasets; this study looks at the feasibility and resource requirement to use deterministic matching to link ambulance and emergency department data for patients conveyed by ambulance to the emergency department.It is possible to link these data, with an average match rate of 81% across 13 emergency departments and one large ambulance trust.All trusts approached provided match-able data and there was an appetite for data linkage; however, it was a long process taking an average of 65 weeks.We conclude that deterministic matching using no patient identifiers can be used in this setting.
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Affiliation(s)
- SJ Clark
- Medical Directorate, London Ambulance Service, London. SE1 8SD
| | - M Halter
- Kingston University and St George’s, University of London, Centre for Health and Social Care Research, London SW17 0RE
| | - A Porter
- Swansea University Medical School, Singleton Park, Swansea SA2 8PP
| | - HC Smith
- Department of Primary Care and Population Health, University College London, London, UK; Formally Nuffield Trust, 59 New Cavendish Street, London, UK
| | - M Brand
- Strategy Directorate, London Ambulance Service, London. SE1 8SD
| | - R Fothergill
- Clinical Audit and Research Unit, London Ambulance Service, London. SE1 0BW
- Clinical Trials Unit, Medical School, Warwick University Faculty of Health, Social Care and Education, Kingston University and St George’s, University of London, London SW17 0RE
| | - SJ Lindridge
- 27 Devonshire Way, Croydon, CR0 8BU. Emergency Care Intensive Support Team, NHS Improvement, London, SE1 8UG; Formerly Medical Directorate, London Ambulance Service NHS Trust, London, SE1 8SD
| | - M McTigue
- Operations West, London Ambulance Service, London. SE1 8SD
| | - H Snooks
- Swansea University Medical School, Singleton Park, Swansea SA2 8PP
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24
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Fishe J, Finlay E, Palmer S, Hendry P. A Geospatial Analysis of Distances to Hospitals that Admit Pediatric Asthma Patients. PREHOSP EMERG CARE 2019; 23:882-886. [PMID: 30874466 DOI: 10.1080/10903127.2019.1593565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Pediatric care is now concentrated in urban specialty centers ("regionalization"), even for common conditions such as asthma. At the same time, rural emergency medical services (EMS) faces challenges related to adequate workforce staffing and financing. This statewide study describes how regionalization of pediatric inpatient care for asthma exacerbations affects EMS operations, particularly for rural agencies. Methods: This is a statewide cross-sectional study of EMS encounters for pediatric asthma in patients aged 2-18 years from 2011 to 2016 using Florida's EMS Tracking and Reporting System (EMSTARS) database. EMSTARS encounters were deterministically linked to Florida's Agency for Healthcare Administration (AHCA) database. We categorized AHCA hospital facilities that received included patients by whether they did or did not admit pediatric asthma patients during the study period ("admitting facility"). We used geospatial analysis to map the EMS agency's home county and the admitting facilities addresses. For each county in Florida, we calculated the average estimated EMS travel distance to the nearest admitting facility using a dasymetric mapping approach. Results: The study included a total of 11,226 EMS pediatric asthma encounters, of which 11,153 (99%) matched to an EMS home county. AHCA data was available for 3,812 (34%) patients. Most counties with distances to admitting facilities less than or equal to 15 miles were urban (31 of 39). For distances of 31-45 miles to an admitting facility, 7 of 8 of counties were rural, and for distances greater than 46 miles, all 4 counties were rural. Conclusions: In this statewide study in Florida, we found long average estimated EMS travel distances to admitting facilities for Florida's pediatric population in rural counties for pediatric asthma exacerbations. Those long distances have great implications for rural EMS operations, including pediatric destination decisions, transport times, and availability for others who call 9-1-1. Further research on bypass and secondary transport rates, and outcomes for asthma and other pediatric conditions are required to further characterize pediatric regionalization's impact on rural EMS.
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