1
|
Kuoppala A, Skaffari E, Iirola T, Nordquist H. The experiences of patients not conveyed after evaluation by emergency medical services in Southwest Finland - A qualitative survey study. Australas Emerg Care 2024:S2588-994X(24)00037-X. [PMID: 38789346 DOI: 10.1016/j.auec.2024.05.001] [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: 03/08/2024] [Revised: 05/16/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND The amount of non-critical Emergency Medical Services missions has been increasing. After examination and treatment, paramedics can decide, based on guidelines, not to convey the patient to a healthcare facility. This study aimed to investigate patients' experiences in non-conveyance situations in Southwest Finland. Our research questions were: 1) Which patient concerns were not addressed? 2) What key actions improved patient comfort? and 3) What possible enhancements could make the patient experience more positive? METHODS This was a qualitative survey study. In March 2023, all the patients who met the inclusion criteria (N = 1017) received a survey via mail. The data from three open-ended questions were analyzed using inductive content analysis. RESULTS The response rate was 22.2 % (n = 226). The unaddressed patient concerns were related to inadequate immediate care and guidance and non-clinical factors causing concern. Key actions for improved patient comfort were related to immediate treatment and guidance, as well as non-clinical factors that impact the patient experience. More thorough treatment processes and more attentive encounters would have enhanced the patient experience. CONCLUSIONS Predominantly, patients reported having received excellent services. Utilizing paramedics' soft skills and keeping the patient as the central focus is key to improving the non-conveyance process and experience.
Collapse
Affiliation(s)
- Anne Kuoppala
- Med Group Ensihoitopalvelu Oy, Emergency Medical Services, Southwest Finland, Teollisuuskuja 8, Lieto FI-21420, Finland
| | - Eetu Skaffari
- Centre for Prehospital Emergency Care, Emergency Medical Services, Wellbeing Services County of Pirkanmaa, Satakunnankatu 16, Tampere FI-33100, Finland
| | - Timo Iirola
- Emergency Medical Services, Turku University Hospital and University of Turku, PO Box 52, Turku FI-20521, Finland
| | - Hilla Nordquist
- South-Eastern Finland University of Applied Sciences, Department of Healthcare and Emergency Care, Pääskysentie 1, Kotka FI-48220, Finland.
| |
Collapse
|
2
|
Mitura KM, Snarska J, Celiński D, Maślach D, Leszczyński PK, Binkowska A, Szpakowski L, Szajda SD. ICD-10 Classification in the Practice of Emergency Medical Teams: New Insights. Emerg Med Int 2024; 2024:8506561. [PMID: 38784856 PMCID: PMC11115992 DOI: 10.1155/2024/8506561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024] Open
Abstract
The role of the emergency medical system is to provide assistance to every person in a state in the event of a sudden threat to health and life. Emergency medical teams (EMTs) are an important element of this system, making diagnoses based on the International Classification of Diseases (ICD-10). The study was aimed at analysing the causes of EMT intervention based on groups of diagnoses codified according to the ICD-10. The analysis was based on data from 116,278 EMT interventions in central-eastern Poland in 2017-2019. The research showed that EMT most often made diagnoses based on groups of ICD-10 codes: R00-R99-Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified (39.11%); S00-T98-Injury, poisoning, and certain other consequences of external causes (18.23%); and I00-I99-Diseases of the circulatory system (15.57%). The analysis of the obtained results showed statistically significant differences (p < 0.0001) regarding the area of intervention (urban, rural), sex, age of the patient, and the method of completion of the activities by EMTs in relation to the group of ICD-10 diagnoses for the diagnosis. The conducted study showed the actual reasons for EMT calls. The use of the ICD-10 classification has practical application in EMTs, as it enables the identification of a disease or health problem.
Collapse
Affiliation(s)
- Krzysztof M. Mitura
- Independent Public Health Care Center RM-MEDITRANS Emergency Station and Sanitary Transport in Siedlce, Siedlce, Poland
| | - Jadwiga Snarska
- Department of Surgery, Collegium Medicum University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Daniel Celiński
- Department of Emergency Medical Service, Medical University of Warsaw, Warsaw, Poland
| | - Dominik Maślach
- Department of Public Health, Medical University of Bialystok, Bialystok, Poland
| | | | - Aneta Binkowska
- Department of Emergency Medical Service, Medical University of Warsaw, Warsaw, Poland
| | - Leszek Szpakowski
- Independent Public Health Care Center RM-MEDITRANS Emergency Station and Sanitary Transport in Siedlce, Siedlce, Poland
| | - Sławomir D. Szajda
- Department of Emergency Medical Service, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| |
Collapse
|
3
|
Harðardóttir GH, Petersen JS, Krarup AL, Christensen EF, Søvsø MB. Deaths Among Ambulance Patients Released from the Emergency Department Within the First 24 Hours With Nonspecific Diagnoses - Expected or Not? J Emerg Med 2024; 66:e571-e580. [PMID: 38693006 DOI: 10.1016/j.jemermed.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/20/2023] [Accepted: 12/08/2023] [Indexed: 05/03/2024]
Abstract
BACKGROUND Emergency patients are frequently assigned nonspecific diagnoses. Nonspecific diagnoses describe observations or symptoms and are found in chapters R and Z of the International Classification of Diseases, 10th edition (ICD-10). Patients with such diagnoses have relatively low mortality, but due to patient volume, the absolute number of deaths is substantial. However, information on cause of short-term mortality is limited. OBJECTIVES To investigate whether death could be expected for ambulance patients brought to the emergency department (ED) after a 1-1-2 call, released with a nonspecific ICD-10 diagnosis within 24 h, and who subsequently died within 30 days. METHODS Retrospective medical record review of adult 1-1-2 emergency ambulance patients brought to an ED in the North Denmark Region during 2017-2021. Patients were divided into three categories: unexpected death, expected death (terminal illness), and miscellaneous. Charlson Comorbidity Index (CCI) was assessed. RESULTS We included 492 patients. Mortality was distributed as follows: Unexpected death 59.2% (n = 291), expected death (terminal illness) 25.8% (n = 127), and miscellaneous 15.0% (n = 74). Patients who died unexpectedly were old (median age of 82 years) and had CCI 1-2 (58.1%); 43.0% used at least five daily prescription drugs, and they were severely acutely ill upon arrival (24.7% with red triage, 60.1% died within 24 h). CONCLUSIONS More than half of ambulance patients released within 24 h from the ED with nonspecific diagnoses, and who subsequently died within 30 days, died unexpectedly. One-fourth died from a pre-existing terminal illness. Patients dying unexpectedly were old, treated with polypharmacy, and often life-threateningly sick at arrival.
Collapse
Affiliation(s)
- Guðný Halla Harðardóttir
- Centre for Prehospital and Emergency Research, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Johnny Strøm Petersen
- Centre for Prehospital and Emergency Research, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Anne L Krarup
- Department of Emergency Medicine and Trauma Center, Aalborg University Hospital, Aalborg, Denmark
| | - Erika F Christensen
- Centre for Prehospital and Emergency Research, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Morten B Søvsø
- Centre for Prehospital and Emergency Research, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
4
|
Gregersen R, Villumsen M, Mottlau KH, Maule CF, Nygaard H, Rasmussen JH, Christensen MB, Petersen J. Acute patients discharged without an established diagnosis: risk of mortality and readmission of nonspecific diagnoses compared to disease-specific diagnoses. Scand J Trauma Resusc Emerg Med 2024; 32:32. [PMID: 38641643 PMCID: PMC11027222 DOI: 10.1186/s13049-024-01191-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/27/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Nonspecific discharge diagnoses after acute hospital courses represent patients discharged without an established cause of their complaints. These patients should have a low risk of adverse outcomes as serious conditions should have been ruled out. We aimed to investigate the mortality and readmissions following nonspecific discharge diagnoses compared to disease-specific diagnoses and assessed different nonspecific subgroups. METHODS Register-based cohort study including hospital courses beginning in emergency departments across 3 regions of Denmark during March 2019-February 2020. We identified nonspecific diagnoses from the R- and Z03-chapter in the ICD-10 classification and excluded injuries, among others-remaining diagnoses were considered disease-specific. Outcomes were 30-day mortality and readmission, the groups were compared by Cox regression hazard ratios (HR), unadjusted and adjusted for socioeconomics, comorbidity, administrative information and laboratory results. We stratified into short (3-<12 h) or lengthier (12-168 h) hospital courses. RESULTS We included 192,185 hospital courses where nonspecific discharge diagnoses accounted for 50.7% of short and 25.9% of lengthier discharges. The cumulative risk of mortality for nonspecific vs. disease-specific discharge diagnoses was 0.6% (0.6-0.7%) vs. 0.8% (0.7-0.9%) after short and 1.6% (1.5-1.7%) vs. 2.6% (2.5-2.7%) after lengthier courses with adjusted HRs of 0.97 (0.83-1.13) and 0.94 (0.85-1.05), respectively. The cumulative risk of readmission for nonspecific vs. disease-specific discharge diagnoses was 7.3% (7.1-7.5%) vs. 8.4% (8.2-8.6%) after short and 11.1% (10.8-11.5%) vs. 13.7% (13.4-13.9%) after lengthier courses with adjusted HRs of 0.94 (0.90-0.98) and 0.95 (0.91-0.99), respectively. We identified 50 clinical subgroups of nonspecific diagnoses, of which Abdominal pain (n = 12,462; 17.1%) and Chest pain (n = 9,599; 13.1%) were the most frequent. The subgroups described differences in characteristics with mean age 41.9 to 80.8 years and mean length of stay 7.1 to 59.5 h, and outcomes with < 0.2-8.1% risk of 30-day mortality and 3.5-22.6% risk of 30-day readmission. CONCLUSIONS In unadjusted analyses, nonspecific diagnoses had a lower risk of mortality and readmission than disease-specific diagnoses but had a similar risk after adjustments. We identified 509 clinical subgroups of nonspecific diagnoses with vastly different characteristics and prognosis.
Collapse
Affiliation(s)
- Rasmus Gregersen
- Department of Emergency Medicine, Copenhagen University Hospital- Bispebjerg and Frederiksberg, Copenhagen, Denmark.
- Center for Clinical Research and Prevention, Copenhagen University Hospital- Bispebjerg and Frederiksberg, Copenhagen, Denmark.
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Marie Villumsen
- Center for Clinical Research and Prevention, Copenhagen University Hospital- Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Katarina Høgh Mottlau
- Department of Emergency Medicine, Copenhagen University Hospital- Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Cathrine Fox Maule
- Center for Clinical Research and Prevention, Copenhagen University Hospital- Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Hanne Nygaard
- Department of Emergency Medicine, Copenhagen University Hospital- Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens Henning Rasmussen
- Department of Emergency Medicine, Copenhagen University Hospital- Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Mikkel Bring Christensen
- Copenhagen Center for Translational Research, Copenhagen University Hospital- Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Pharmacology, Copenhagen University Hospital- Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Janne Petersen
- Center for Clinical Research and Prevention, Copenhagen University Hospital- Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
5
|
Skaffari E, Iirola T, Nordquist H. Patient experience of non-conveyance in the EMS of Southwest Finland: a descriptive survey study. BMC Emerg Med 2024; 24:42. [PMID: 38475735 DOI: 10.1186/s12873-024-00961-8] [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: 11/06/2023] [Accepted: 03/06/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Emergency Medical Services are dispatched more frequently than before. However, many non-urgent patients do not need ambulance transportation to a healthcare facility after evaluation and treatment on scene. This study explored the experiences of non-conveyed patients. Our research questions were: (1) How have non-conveyed patients experienced the service received from EMS? (2) Does a patient's age, gender, or time of the emergency call impact the patient's experience? METHODS This descriptive survey study examined non-conveyed Emergency Medical Services patients in the Wellbeing Services County of Southwest Finland. The study period was from March 1, 2023, to March 31, 2023. The study population was 1017. They received a questionnaire that was sent by mail. The questionnaire was formed based on questions previously used in four different questionnaires. We received 247 answers (24.3% response rate). Percentages, medians with interquartile ranges, and non-parametric tests were used in the descriptive analyses. RESULTS Non-conveyed patients were very satisfied with the paramedics' expertise and behavior, their ability to meet their individual needs, the sense of safety provided by the paramedics, and the instructions given to the patients. Time to receive help (19% rated 3 or less on a scale from 1 to 5), how paramedics introduced themselves (16.5%), and satisfaction with non-conveyance decisions (14.6%) were more frequently rated lower than other areas. Further, pain management stood out in the less favorable evaluations. Still, patients' experiences of the service were positive. The age group, gender, or time of the emergency call were not associated with patient experience. CONCLUSIONS Patients were very satisfied with the paramedics' interpersonal skills. A more focused approach to pain management and developing EMS to ensure faster patient outreach and clearer explanations of non-conveyance decisions could further enhance the patient experience.
Collapse
Affiliation(s)
- Eetu Skaffari
- Centre for Prehospital Emergency Care, Emergency Medical Services, Wellbeing Services County of Pirkanmaa, Satakunnankatu 16, FI-33100, Tampere, Finland
| | - Timo Iirola
- Emergency Medical Services, Turku University Hospital and University of Turku, FI-20521, Turku, PO Box 52, Finland
| | - Hilla Nordquist
- Department of Healthcare and Emergency Care, South-Eastern Finland University of Applied Sciences, Pääskysentie 1, FI-48220, Kotka, Finland.
| |
Collapse
|
6
|
Næss LE, Krüger AJ, Uleberg O, Haugland H, Dale J, Wattø JO, Nilsen SM, Asheim A. Using machine learning to assess the extent of busy ambulances and its impact on ambulance response times: A retrospective observational study. PLoS One 2024; 19:e0296308. [PMID: 38181019 PMCID: PMC10769093 DOI: 10.1371/journal.pone.0296308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/09/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Ambulance response times are considered important. Busy ambulances are common, but little is known about their effect on response times. OBJECTIVE To assess the extent of busy ambulances in Central Norway and their impact on ambulance response times. DESIGN This was a retrospective observational study. We used machine learning on data from nearby incidents to assess the probability of up to five different ambulances being candidates to respond to a medical emergency incident. For each incident, the probability of a busy ambulance was estimated by summing the probabilities of candidate ambulances being busy at the time of the incident. The difference in response time that may be attributable to busy ambulances was estimated by comparing groups of nearby incidents with different estimated busy probabilities. SETTING Medical emergency incidents with ambulance response in Central Norway from 2013 to 2022. MAIN OUTCOME MEASURES Prevalence of busy ambulances and differences in response times associated with busy ambulances. RESULTS The estimated probability of busy ambulances for all 216,787 acute incidents with ambulance response was 26.7% (95% confidence interval (CI) 26.6 to 26.9). Comparing nearby incidents, each 10-percentage point increase in the probability of a busy ambulance was associated with a delay of 0.60 minutes (95% CI 0.58 to 0.62). For incidents in rural and urban areas, the probability of a busy ambulance was 21.6% (95% CI 21.5 to 21.8) and 35.0% (95% CI 34.8 to 35.2), respectively. The delay associated with a 10-percentage point increase in busy probability was 0.81 minutes (95% CI 0.78 to 0.84) and 0.30 minutes (95% CI 0.28 to 0.32), respectively. CONCLUSION Ambulances were often busy, which was associated with delayed ambulance response times. In rural areas, the probability of busy ambulances was lower, although the potentially longer delays when ambulances were busy made these areas more vulnerable.
Collapse
Affiliation(s)
- Lars Eide Næss
- Department of Research and Development, The Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav’s University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Andreas Jørstad Krüger
- Department of Research and Development, The Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav’s University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Oddvar Uleberg
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav’s University Hospital, Trondheim, Norway
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway
| | - Helge Haugland
- Department of Research and Development, The Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav’s University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jostein Dale
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav’s University Hospital, Trondheim, Norway
| | - Jon-Ola Wattø
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav’s University Hospital, Trondheim, Norway
| | - Sara Marie Nilsen
- Center for Health Care Improvement, St. Olav’s University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Andreas Asheim
- Center for Health Care Improvement, St. Olav’s University Hospital, Trondheim, Norway
- Department of Mathematical Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
7
|
Petersen M, Kjeldtoft FG, Christensen EF, Bøggild H, Lindskou TA. A classification system for identifying patients dead on ambulance arrival: a prehospital medical record review. Scand J Trauma Resusc Emerg Med 2023; 31:107. [PMID: 38129908 PMCID: PMC10740259 DOI: 10.1186/s13049-023-01171-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Patients dead before arrival of the ambulance or before arrival at hospital may be in- or excluded in mortality analyses, making comparison of mortality difficult. Often only physicians are allowed to declare death, thereby impeding uniform registration of prehospital death. Many studies do not report detailed definitions of prehospital mortality. Our aim was to define criteria to identify and categorize prehospital patients' vital status, and to estimate the proportion of these groups, primarily the proportion of patients dead on ambulance arrival. METHODS Prehospital medical records review for patients receiving an ambulance in the North Denmark Region from 2019 to 2021 and registered dead on the same or the following day. We defined three vital status categories: (1) Dead on Ambulance Arrival (DOAA), (2) Out-of-Hospital Cardiac Arrest (OHCA) divided into OHCA Basic Life Support (OHCA BLS) and OHCA Advanced treatment, and 3) Alive on Ambulance Arrival. RESULTS Among 3 174 dead patients, DOAA constituted 28.8%, OHCA BLS 13.4%, OHCA Advanced treatment 31.3%, and Alive on Ambulance Arrival 26.6%. CONCLUSION We defined exhaustive and mutually exclusive criteria to define vital status, DOAA, OHCA, and Alive on Ambulance Arrival based on prehospital medical records. More than one out of four patients receiving an ambulance and registered dead on the same or the following day were dead already at ambulance arrival. Adding OHCA BLS where resuscitation was terminated without defibrillation or other treatment, increased the proportion of patients dead on ambulance arrival to 42%. We recommend reporting similar categories of vital status to improve valid comparisons of prehospital mortality rates.
Collapse
Affiliation(s)
- Markus Petersen
- Centre for Prehospital and Emergency Research, Aalborg University Hospital and Department of Clinical Medicine, Aalborg University, Gistrup, Denmark
| | - Fredderick Georg Kjeldtoft
- Centre for Prehospital and Emergency Research, Aalborg University Hospital and Department of Clinical Medicine, Aalborg University, Gistrup, Denmark
| | - Erika Frischknecht Christensen
- Centre for Prehospital and Emergency Research, Aalborg University Hospital and Department of Clinical Medicine, Aalborg University, Gistrup, Denmark
- Department of Emergency and Trauma Care, Clinic of Internal and Emergency Medicine, Aalborg, Denmark
| | - Henrik Bøggild
- Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
- Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Tim Alex Lindskou
- Centre for Prehospital and Emergency Research, Aalborg University Hospital and Department of Clinical Medicine, Aalborg University, Gistrup, Denmark.
| |
Collapse
|
8
|
Wolthers SA, Blomberg SNF, Breindahl N, Anjum S, Hägi-Pedersen D, Ersbøll A, Andersen LB, Christensen HC. Association between using a prehospital assessment unit and hospital admission and mortality: a matched cohort study. BMJ Open 2023; 13:e075592. [PMID: 37739475 PMCID: PMC10533654 DOI: 10.1136/bmjopen-2023-075592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/04/2023] [Indexed: 09/24/2023] Open
Abstract
OBJECTIVES This study aimed to compare hospital admission and 30-day mortality between patients assessed by the prehospital assessment unit (PAU) and patients not assessed by the PAU. DESIGN This was a matched cohort study. SETTING This study was conducted between November 2021 and October 2022 in Region Zealand, Denmark. PARTICIPANTS 989 patients aged >18, assessed by the PAU, were identified, and 9860 patients not assessed by the PAU were selected from the emergency calls using exposure density sampling. EXPOSURE Patients assessed by the PAU. The PAU is operated by paramedics with access to point-of-care test facilities. The PAU is an alternative response vehicle without the capability of transporting patients. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was hospital admission within 48 hours after the initial call. The key secondary outcomes were admission within 7 days, 30-day mortality and admission within 6 hours. Descriptive statistical analyses were conducted, and logistic regression models were used to estimate adjusted OR (aOR) and 95% CI. RESULTS Among the PAU assessed, 44.1% were admitted within 48 hours, compared with 72.9% of the non-PAU assessed, p<0.001. The multivariable analysis showed a lower risk of admission within 48 hours and 7 days among the PAU patients, aOR 0.31 (95% CI 0.26 to 0.38) and aOR 0.50 (95% CI 0.38 to 0.64), respectively. The 30-day mortality rate was 3.8% in the PAU-assessed patients vs 5.5% in the non-PAU-assessed patients, p=0.03. In the multivariable analysis, no significant difference was found in mortality aOR 0.99 (95% CI 0.71 to 1.42). No deaths were observed in PAU-assessed patients without subsequent follow-up. CONCLUSION The recently introduced PAU aims for patient-centred emergency care. The PAU-assessed patients had reduced admissions within 48 hours and 7 days after the initial call. Study findings indicate that the PAU is safe since we identified no significant differences in 30-day mortality. TRIAL REGISTRATION NUMBER NCT05654909.
Collapse
Affiliation(s)
- Signe Amalie Wolthers
- Prehospital Center, Region Zealand, Naestved, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Niklas Breindahl
- Prehospital Center, Region Zealand, Naestved, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sair Anjum
- Department of Anaesthesiology, Slagelse University Hospital, Slagelse, Denmark
| | | | - Annette Ersbøll
- University of Southern Denmark National Institute of Public Health, Copenhagen, Denmark
| | | | - Helle Collatz Christensen
- Prehospital Center, Region Zealand, Naestved, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
9
|
Mitura KM, Celiński D, Jastrzębski P, Leszczyński PK, Gałązkowski R, Szajda SD. Characteristics of Emergencies in the Workplace from the Perspective of the Emergency Medical Services: A 4-Year Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1863. [PMID: 36767231 PMCID: PMC9953414 DOI: 10.3390/ijerph20031863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Accidents and emergencies in the workplace account for a significant proportion of emergency calls worldwide. The specificity of these events is often associated with hazards at a given workplace. Patients do not always require hospitalization; therefore, the characteristics of events can only be determined from the perspective of emergency medical services teams. The aim of the study was to analyze calls and the course of emergency ambulance interventions to patients at their workplace. MATERIAL AND METHODS The study was conducted based on a retrospective analysis of data contained in the medical records of the ambulance service from central Poland from 2015-2018. From all interventions (n = 155,993), 1601 calls to work were selected, and the urgency code, time of day and year, patients' sex, general condition, as well as diagnoses according to the International Classification of Diseases-ICD-10 and the method of ending the call were considered. RESULTS The mean age of patients in the study group was 42.4 years (SD ± 13.5). The majority were men (n = 918; 57.3%). The number of calls increased in the autumn (n = 457; 28.5%) and in the morning (n = 609; 38.0%). The main reasons for the intervention were illnesses (ICD-10 group: R-'symptoms') and injuries (ICD-10 group: S, T-'injuries'). Calls at workplaces most often ended with the patient being transported to the hospital (78.8%), and least often with his death (0.8%). CONCLUSIONS The patient profile in the workplace indicates middle-aged men who fall ill in the fall, requiring transport to the hospital and further diagnostics.
Collapse
Affiliation(s)
- Krzysztof Marek Mitura
- Independent Public Health Care Center RM-MEDITRANS Emergency Station and Sanitary Transport in Siedlce, 08-110 Siedlce, Poland
| | - Daniel Celiński
- Department of Emergency Medical Service, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Paweł Jastrzębski
- Department of Emergency Medical Service, Faculty of Health Sciences Collegium Medicum, University of Warmia and Mazury, 10-719 Olsztyn, Poland
| | - Piotr Konrad Leszczyński
- Faculty of Medical Sciences and Health Sciences, Siedlce University of Natural Sciences and Humanities, 08-110 Siedlce, Poland
| | - Robert Gałązkowski
- Department of Emergency Medical Service, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Sławomir Dariusz Szajda
- Department of Emergency Medical Service, Faculty of Health Sciences Collegium Medicum, University of Warmia and Mazury, 10-719 Olsztyn, Poland
| |
Collapse
|
10
|
Arvig M, Mogensen C, Skjøt-Arkil H, Johansen I, Rosenvinge F, Lassen A. Chief Complaints, Underlying Diagnoses, and Mortality in Adult, Non-trauma Emergency Department Visits: A Population-based, Multicenter Cohort Study. West J Emerg Med 2022; 23:855-863. [PMID: 36409936 PMCID: PMC9683768 DOI: 10.5811/westjem.2022.9.56332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 09/10/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Knowledge about the relationship between symptoms, diagnoses, and mortality in emergency department (ED) patients is essential for the emergency physician to optimize treatment, monitoring, and flow. In this study, we investigated the association between symptoms and discharge diagnoses; symptoms and mortality; and we then analyzed whether the association between symptoms and mortality was influenced by other risk factors. Methods This was a population-based, multicenter cohort study of all non-trauma ED patients ≥18 years who presented at a hospital in the Region of Southern Denmark between January 1, 2016–March 20, 2018. We used multivariable logistic regression to examine the association between symptoms and mortality adjusted for other risk factors. Results We included 223,612 ED visits with a median patient age of 63 and even distribution of females and males. The frequency of the chief complaints at presentation were as follows: non-specific symptoms (19%); abdominal pain (16%); dyspnea (12%); fever (8%); chest pain (8%); and neurologic complaints (7%). Discharge diagnoses were symptom-based (24%), observational (hospital visit for observation or examination, 17%), circulatory (12%), or respiratory (12%). The overall 30-day mortality was 3.5%, with 1.7% dead within 0–7 days and 1.8% within 8–30 days. The presenting symptom was associated with mortality at 0–7 days but not with mortality at 8–30 days. Patients whose charts were missing documentation of symptoms (adjusted odds ratio [aOR] 3.5) and dyspneic patients (aOR 2.4) had the highest mortality at 0–7 days across patients with different primary symptoms. Patients ≥80 years and patients with a higher degree of comorbidity had increased mortality from 0–7 days to 8–30 days (aOR from 24.0 to 42.7 and 1.9 to 2.8, respectively). Conclusion Short-term mortality was more strongly associated with patient-related factors than with the primary presenting symptom at arrival to the hospital.
Collapse
Affiliation(s)
- Michael Arvig
- Slagelse Hospital, Department of Emergency Medicine, Slagelse, Denmark; University of Copenhagen, Department of Clinical Medicine, Copenhagen, Denmark; University of Southern Denmark, Department of Clinical Research, Odense, Denmark
| | - Christian Mogensen
- University Hospital of Southern Denmark, Department of Emergency Medicine, Aabenraa, Denmark; University of Southern Denmark, Department of Regional Health Research, Odense, Denmark
| | - Helene Skjøt-Arkil
- University Hospital of Southern Denmark, Department of Emergency Medicine, Aabenraa, Denmark; University of Southern Denmark, Department of Regional Health Research, Odense, Denmark
| | - Isik Johansen
- Odense University Hospital, Department of Infectious Diseases, Odense, Denmark; Clinical Institute, University of Southern Denmark, Research Unit for Infectious Diseases, Odense, Denmark; University of Southern Denmark, Odense University, Hospital, Open Patient data Explorative Network (OPEN), Odense, Denmark
| | - Flemming Rosenvinge
- Odense University Hospital, Department of Clinical Microbiology, Odense, Denmark; University of Southern Denmark, Research Unit of Clinical Microbiology, Odense, Denmark
| | - Annmarie Lassen
- University of Southern Denmark, Department of Clinical Research, Odense, Denmark; Odense University Hospital, Department of Emergency Medicine, Odense, Denmark
| |
Collapse
|
11
|
Otten S, Rehbock C, Krafft T, Haugaard MV, Pilot E, Blomberg SN, Christensen HC. The “unclear problem” category: an analysis of its patient and dispatch characteristics and its trend over time. BMC Emerg Med 2022; 22:41. [PMID: 35279086 PMCID: PMC8917690 DOI: 10.1186/s12873-022-00597-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 02/25/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
An effective emergency medical dispatch process is vital to provide appropriate prehospital care to patients. It increases patient safety and ensures the sustainable use of medical resources. Although Copenhagen has a sophisticated emergency medical services (EMS) system with a significant focus on public welfare, more than 10% of emergency cases are still being categorized as an "unclear problem category" (UPC) and are thus not categorized as "symptom-specific". Therefore, the objective of this research is to gain a better understanding of the patient and dispatch characteristics of emergency cases categorized as "unclear".
Methods
This register-based study based on medical emergency cases data describes patient and dispatch characteristics of emergency cases categorized as “unclear” through the use of numbers and proportions. Moreover, these cases were compared to non UPC cases. Use of UPC was stratified by month to determine the impact of alerting medical dispatchers to reduce its use.
Results
From 296,398 included cases UPC accounted for 11.4% of the cases. The median age of those triaged with the UPC was 66 years vs 58 years for individuals triaged with other symptom-specific categories.
Moreover, after having been triaged with the UPC, 9,661 (34.7%) of the dispatched EMS vehicles ended up being cancelled. Sensitizing medical dispatchers about the use of the UPC likely contributed to the decreased use of the UPC over time.
Conclusion
The UPC has different dispatch characteristics than the symptom-specific categories, with potential negative effects on the medical dispatch process. Moreover, the median age of individuals triaged with the UPC is higher than those triaged with symptom-specific categories. Nonetheless, the use of the UPC decreased throughout the study period after the medical dispatchers were alerted about the implications of its use.
Collapse
|
12
|
van Meenen LCC, van Stigt MN, Siegers A, Smeekes MD, van Grondelle JAF, Geuzebroek G, Marquering HA, Majoie CBLM, Roos YBWEM, Koelman JHTM, Potters WV, Coutinho JM. Detection of Large Vessel Occlusion Stroke in the Prehospital Setting: Electroencephalography as a Potential Triage Instrument. Stroke 2021; 52:e347-e355. [PMID: 33940955 DOI: 10.1161/strokeaha.120.033053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A reliable and fast instrument for prehospital detection of large vessel occlusion (LVO) stroke would be a game-changer in stroke care, because it would enable direct transportation of LVO stroke patients to the nearest comprehensive stroke center for endovascular treatment. This strategy would substantially improve treatment times and thus clinical outcomes of patients. Here, we outline our view on the requirements of an effective prehospital LVO detection method, namely: high diagnostic accuracy; fast application and interpretation; user-friendliness; compactness; and low costs. We argue that existing methods for prehospital LVO detection, including clinical scales, mobile stroke units and transcranial Doppler, do not fulfill all criteria, hindering broad implementation of these methods. Instead, electroencephalography may be suitable for prehospital LVO detection since in-hospital studies have shown that quantification of hypoxia-induced changes in the electroencephalography signal have good diagnostic accuracy for LVO stroke. Although performing electroencephalography measurements in the prehospital setting comes with challenges, solutions for fast and simple application of this method are available. Currently, the feasibility and diagnostic accuracy of electroencephalography in the prehospital setting are being investigated in clinical trials.
Collapse
Affiliation(s)
- Laura C C van Meenen
- Department of Neurology (L.C.C.v.M., Y.B.W.E.M.R., W.V.P., J.M.C.), Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Maritta N van Stigt
- Department of Clinical Neurophysiology (M.N.v.S., J.H.T.M.K., W.V.P.), Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Arjen Siegers
- Ambulance Amsterdam, Amsterdam, the Netherlands (A.S., J.A.F.v.G., G.G.)
| | - Martin D Smeekes
- Emergency Medical Services North-Holland North, Alkmaar, the Netherlands (M.D.S.)
| | | | - Geertje Geuzebroek
- Ambulance Amsterdam, Amsterdam, the Netherlands (A.S., J.A.F.v.G., G.G.)
| | - Henk A Marquering
- Department of Biomedical Engineering and Physics (H.A.M.), Amsterdam UMC, University of Amsterdam, the Netherlands.,Department of Radiology and Nuclear Medicine (H.A.M., C.B.L.M.M.), Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine (H.A.M., C.B.L.M.M.), Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Yvo B W E M Roos
- Department of Neurology (L.C.C.v.M., Y.B.W.E.M.R., W.V.P., J.M.C.), Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Johannes H T M Koelman
- Department of Clinical Neurophysiology (M.N.v.S., J.H.T.M.K., W.V.P.), Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Wouter V Potters
- Department of Neurology (L.C.C.v.M., Y.B.W.E.M.R., W.V.P., J.M.C.), Amsterdam UMC, University of Amsterdam, the Netherlands.,Department of Clinical Neurophysiology (M.N.v.S., J.H.T.M.K., W.V.P.), Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Jonathan M Coutinho
- Department of Neurology (L.C.C.v.M., Y.B.W.E.M.R., W.V.P., J.M.C.), Amsterdam UMC, University of Amsterdam, the Netherlands
| |
Collapse
|
13
|
Ibsen S, Lindskou TA, Nickel CH, Kløjgård T, Christensen EF, Søvsø MB. Which symptoms pose the highest risk in patients calling for an ambulance? A population-based cohort study from Denmark. Scand J Trauma Resusc Emerg Med 2021; 29:59. [PMID: 33879211 PMCID: PMC8056716 DOI: 10.1186/s13049-021-00874-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/07/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Emergency medical service patients are a vulnerable population and the risk of mortality is considerable. In Denmark, healthcare professionals receive 112-emergency calls and assess the main reason for calling. The main aim was to investigate which of these reasons, i.e. which symptoms or mechanism of injury, contributed to short-term risk of death. Secondary aim was to study 1-30 day-mortality for each symptom/ injury. METHODS Historic population-based cohort study of emergency medical service patients calling 112 in the North Denmark Region between 01.01.2016-31.12.2018. We defined 1-day mortality as death on the same or the following day. The frequency of each symptom and cumulative number of deaths on day 1 and 30 together with 1- and 30-day mortality for each symptom/mechanism of injury is presented in proportions. Poisson regression with robust variance estimation was used to estimate incident rates (IR) of mortality with 95% confidence intervals (CI), crude and age and sex adjusted, mortality rates on day 1 per 100,000 person-year in the population. RESULTS The five most frequent reasons for calling 112 were "chest pain" (15.9%), "unclear problem" (11.9%), "accidents" (11.2%), "possible stroke" (10.9%), and "breathing difficulties" (8.3%). Four of these contributed to the highest numbers of deaths: "breathing difficulties" (17.2%), "unclear problem" (13.2%), "possible stroke" (8.7%), and "chest pain" (4.7%), all exceeded by "unconscious adult - possible cardiac arrest" (25.3%). Age and sex adjusted IR of mortality per 100,000 person-year was 3.65 (CI 3.01-4.44) for "unconscious adult - possible cardiac arrest" followed by "breathing difficulties" (0.45, CI 0.37-0.54), "unclear problem"(0.30, CI 0.11-0.17), "possible stroke"(0.13, CI 0.11-0.17) and "chest pain"(0.07, CI 0.05-0.09). CONCLUSION In terms of risk of death on the same day and the day after the 112-call, "unconscious adult/possible cardiac arrest" was the most deadly symptom, about eight times more deadly than "breathing difficulties", 12 times more deadly than "unclear problem", 28 times more deadly than "possible stroke", and 52 times more deadly than "chest pain". "Breathing difficulties" and "unclear problem" as presented when calling 112 are among the top three contributing to short term deaths when calling 112, exceeding both stroke symptoms and chest pain.
Collapse
Affiliation(s)
- Stine Ibsen
- Centre for Prehospital and Emergency Research, Aalborg University and Aalborg University Hospital, Aalborg, Denmark.
| | - Tim Alex Lindskou
- Centre for Prehospital and Emergency Research, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Christian H Nickel
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Torben Kløjgård
- Centre for Prehospital and Emergency Research, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | | | | |
Collapse
|
14
|
van Doorn SCM, Verhalle RC, Ebben RHA, Frost DM, Vloet LCM, de Brouwer CPM. The experience of non-conveyance following emergency medical service triage from the perspective of patients and their relatives: A qualitative study. Int Emerg Nurs 2020; 54:100952. [PMID: 33383408 DOI: 10.1016/j.ienj.2020.100952] [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: 04/21/2020] [Revised: 09/21/2020] [Accepted: 11/21/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND As many as 25% of all Dutch ambulance emergency service assignments result in non-conveyance of the patient to the hospital. Little is known about how patients and their relatives experience being left at home by an ambulance nurse after an acute request for medical help. AIM To gain insight into the experience of patients and their relatives with a high urgency request for ambulance assistance that results in non-conveyance, with the ultimate goal of offering adequate follow-up. METHOD A qualitative design based on semi-structured interviews with fifteen patients and seven relatives, conducted between September and November 2018. RESULTS Four themes emerged from the thematic analysis: Fear as the prominent emotion, four components of confidence in decision-making, different consequences and coping between patient and relative(s) over time and the perceived need for evaluation afterwards. CONCLUSION The experience after non-conveyance has several phases in which fear, reassurance, confirmation (for relatives) and shame (for patients) follow each other throughout the care process. Complex interpersonal skills of ambulance nurses congruent with the concept of person-centred care can modulate this impact. These findings offer starting points for the optimisation of training programmes within the ambulance care sector.
Collapse
Affiliation(s)
| | - Ruud C Verhalle
- Ambulance Service Brabant Midden West Noord, 's-Hertogenbosch, The Netherlands.
| | - Remco H A Ebben
- HAN University of Applied Sciences, School of Health Studies, Knowledge Centre of Sustainable Healthcare, Research Department of Emergency and Critical Care, Nijmegen, The Netherlands.
| | - Donna M Frost
- Fontys University of Applied Sciences, Faculty of People and Health, Master Advanced Nursing Practice, The Netherlands.
| | - Lilian C M Vloet
- HAN University of Applied Sciences, School of Health Studies, Knowledge Centre of Sustainable Healthcare, Research Department of Emergency and Critical Care, Nijmegen, The Netherlands; Radboud University Medical Center, Nijmegen, IQ Healthcare, The Netherlands.
| | - Carin P M de Brouwer
- Fontys University of Applied Sciences, Faculty of People and Health, Master Advanced Nursing Practice, The Netherlands.
| |
Collapse
|
15
|
Hjalmarsson A, Holmberg M, Asp M, Östlund G, Nilsson KW, Kerstis B. Characteristic patterns of emergency ambulance assignments for older adults compared with adults requiring emergency care at home in Sweden: a total population study. BMC Emerg Med 2020; 20:94. [PMID: 33267796 PMCID: PMC7709262 DOI: 10.1186/s12873-020-00387-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/16/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Since the vast majority of older adults in Sweden live in their private homes throughout life, the emergency medical services need to adapt accordingly. Hence, we aimed to describe characteristic patterns of dyadic staffed emergency ambulance assignments for older adults aged > 70 years compared with adults aged 18-69 years requiring emergency care at home in Sweden. METHODS A descriptive retrospective study was performed using anonymized registry data from the emergency medical services in a region of Sweden during 2017-2018. One-sample χ2 test, one-way analysis of variance, and binary logistic regression models were used for investigating group differences. Variables for analysis were age, gender, clinical assessments, on-scene time, priority levels, result of response, and temporal patterns. RESULTS Of all included emergency ambulance assignments (n = 28,533), 59.9% involved older adults, of which 53.8% were women. The probability for older adults to receive the highest priority was decreased for both dispatch (p < 0.001, odds ratio [OR] 0.63, 95% confidence interval [CI] 0.59-0.66), and transport priorities (p < 0.001, OR 0.74, 95% CI 0.68-0.80). Older adults were more likely to receive dispatch priority levels 2 (p < 0.001, OR 1.48, 95% CI 1.40-1.56), and 3 (p < 0.001, OR 1.73, 95% CI 1.46-2.06). The older adults were similarly more likely to receive transport priority level 3 (p < 0.001, OR 1.40, 95% CI 1.28-1.52) compared with adults. Age had a small but additive effect in relation to on-scene time (p < 0.001, R2 = 0.01, F = 53.82). Distinguishing initial clinical assessments for older adults were circulatory, respiratory, trauma, infection, and nonspecific assessments. Emergency ambulance assignments for older adults were more frequently occurring on Mondays (p < 0.001, χ2 = 232.56), and in the 08:00-11:59 interval (p < 0.001, χ2 = 1224.08). CONCLUSION The issues of the lower priority level preponderance, and the decreased probability for receiving the highest priority warrant further attention in future research and clinical practice.
Collapse
Affiliation(s)
- Anna Hjalmarsson
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna Västerås, Sweden.
| | - Mats Holmberg
- Faculty of Health and Life Sciences, Linneaus University, Växjö, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.,Department of Ambulance Service, Region Sörmland, Eskilstuna, Sweden
| | - Margareta Asp
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna Västerås, Sweden
| | - Gunnel Östlund
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna Västerås, Sweden
| | - Kent W Nilsson
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna Västerås, Sweden.,Centre for Clinical Research Västerås, Uppsala University, Västmanland County Hospital, Västerås, Sweden
| | - Birgitta Kerstis
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna Västerås, Sweden
| |
Collapse
|
16
|
Lindskou TA, Lübcke K, Kløjgaard TA, Laursen BS, Mikkelsen S, Weinreich UM, Christensen EF. Predicting outcome for ambulance patients with dyspnea: a prospective cohort study. J Am Coll Emerg Physicians Open 2020; 1:163-172. [PMID: 33000031 PMCID: PMC7493583 DOI: 10.1002/emp2.12036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/05/2020] [Accepted: 02/10/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To validate the discrimination and classification accuracy of a novel acute dyspnea scale for identifying outcomes of out-of-hospital patients with acute dyspnea. METHODS Prospective observational population-based study in the North Denmark Region. We included patients from July 1, 2017 to September 24, 2019 assessed as having acute dyspnea by the emergency dispatcher or by emergency medical services (EMS) personnel. Patients rated dyspnea using the 11-point acute dyspnea scale. The primary outcomes were hospitalization >2 days, ICU admission within 48 hours of ambulance run, and 30-day mortality. We used 5-fold cross-validation and area under receiver operating curves (AUC) to assess predictive properties of the acute dyspnea scale score alone and combined with vital data, age, and sex. RESULTS We included 3144 EMS patients with reported dyspnea. Median acute dyspnea scale score was 7 (interquartile range 5 to 8). The outcomes were: 1966 (63%) hospitalized, 164 (5%) ICU stay, and 224 (9%) died within 30 days of calling the ambulance. The acute dyspnea scale score alone showed poor discrimination for hospitalization (AUC 0.56, 95% confidence intervals: 0.54-0.58), intensive care unit admission (0.58, 0.53-0.62), and mortality (0.46, 0.41-0.50). Vital signs (respiratory rate, blood oxygen saturation, blood pressure, and heart rate) showed similarly poor discrimination for all outcomes. The combination of [vital signs + acute dyspnea scale score] showed better discrimination for hospitalization, ICU admission, and mortality (AUC 0.71-0.72). Patients not able to report an acute dyspnea scale score worse outcomes on all parameters. CONCLUSION The dyspnea scale showed poor accuracy and discrimination when predicting hospitalization, stay at intensive care unit, and mortality on its own. However, the dyspnea scale may be beneficial as performance measure and indicator of out-of-hospital care.
Collapse
Affiliation(s)
- Tim Alex Lindskou
- Department of Clinical MedicineCentre for Prehospital and Emergency ResearchAalborg UniversityAalborgDenmark
| | - Kenneth Lübcke
- Emergency Medical ServicesNorth Denmark RegionAalborgDenmark
| | - Torben Anders Kløjgaard
- Department of Clinical MedicineCentre for Prehospital and Emergency ResearchAalborg UniversityAalborgDenmark
| | | | - Søren Mikkelsen
- Department of Regional Health ResearchUniversity of Southern DenmarkOdenseDenmark
| | | | | |
Collapse
|
17
|
Brøchner AC, Binderup LG, Schaffalitzky de Muckadell C, Mikkelsen S. Does the "Morning Morality Effect" Apply to Prehospital Anaesthesiologists? An Investigation into Diurnal Changes in Ethical Behaviour. Healthcare (Basel) 2020; 8:healthcare8020101. [PMID: 32316371 PMCID: PMC7349197 DOI: 10.3390/healthcare8020101] [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: 04/07/2020] [Accepted: 04/14/2020] [Indexed: 12/02/2022] Open
Abstract
The “morning morality effect”—the alleged phenomenon that people are more likely to act in unethical ways in the afternoon when they are tired and have less self-control than in the morning—may well be expected to influence prehospital anaesthesiologist manning mobile emergency care units (MECUs). The working conditions of these units routinely entail fatigue, hunger, sleep deprivation and other physical or emotional conditions that might make prehospital units predisposed to exhibit the “morning morality effect”. We investigated whether this is in fact the case by looking at the distribution of patient transports to hospital with and without physician escort late at night at the end of the shift as a surrogate marker for changing thresholds in ethical behaviour. All missions over a period of 11 years in the MECU in Odense were reviewed. Physician-escorted transports to hospital were compared with non-physician-escorted transports during daytime, evening, and night-time (which correlates with time on the 24 h shifts). In total, 26,883 patients were transported to hospital following treatment by the MECU. Of these, 27.4% (26.9%–27.9%) were escorted to the hospital. The ratio of patient transports to hospital with and without physician escort during the three periods of the day did not differ (p = 1.00). We found no evidence of changes in admission patterns over the day. Thus, no evidence of the expected “morning morality effect” could be found in a prehospital physician-manned emergency care unit.
Collapse
Affiliation(s)
- Anne Craveiro Brøchner
- Department of Anaesthesiology and Intensive Care Medicine V, Mobile Emergency Care Unit, Odense University Hospital, 5000 Odense, Denmark;
- Department of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
- Department of Anaesthesiology, Kolding Hospital, a Part of Hospital Lillebaelt, 6000 Kolding, Denmark
| | - Lars Grassmé Binderup
- Philosophy, Department for the Study of Culture, University of Southern Denmark, 5230 Odense, Denmark; (L.G.B.); (C.S.d.M.)
| | | | - Søren Mikkelsen
- Department of Anaesthesiology and Intensive Care Medicine V, Mobile Emergency Care Unit, Odense University Hospital, 5000 Odense, Denmark;
- Department of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
- Correspondence: ; Tel.: +45-30252225
| |
Collapse
|
18
|
Aitavaara-Anttila M, Liisanantti J, Ehrola A, Spalding M, Ala-Kokko T, Raatiniemi L. Use of prehospital emergency medical services according to income of residential area. Emerg Med J 2020; 37:429-433. [DOI: 10.1136/emermed-2019-208834] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 02/27/2020] [Accepted: 03/03/2020] [Indexed: 11/04/2022]
Abstract
BackgroundThe increasing usage of emergency medical services (EMS) missions is a challenge in modern practice. This study was designed to examine the association of the income level of residential areas on the rate of EMS missions and the frequency of EMS use in these areas.MethodsAll EMS missions for adult patients (>18 years) encountered by one rescue department in Northern Finland between June 2015 and May 2017 were analysed. The area served was categorised into four categories, according to the median annual income of the postal code areas. EMS missions per 1000 person-years, rate of non-transport missions and the number of dispatches to frequent (>4 EMS calls/year and highly frequent (>10 calls/year)EMS users per area were investigated.ResultsThere were 62 759 EMS missions, 34.8% of which resulted in non-transport. The crude rate of EMS dispatches was higher in the low-income area compared with other income areas (133.3 vs 108.9 vs 111.3 vs 73.6/1000 person-years) as well as the rate of high-frequency user dispatches (21.5 vs 11.5 vs 7.2 vs 4.3/1000-person years). The rate of non-transports missions was higher also (69.4 vs 43.4 vs 42.5. vs 30.6/1000 person-years). The highest crude rate of EMS use was found in people older than 65 years living in the lowest income areas (294.8/1000 person-years). After age adjustment, the highest rate of EMS use was found in rural areas with the lowest income (146.3/1000 person-years).ConclusionsThe rate of the EMS missions and non-transport missions differs significantly among different income areas. Resource usage was significantly higher in the low income areas. This information can be used in planning allocation of EMS and preventive healthcare resources.
Collapse
|
19
|
Huibers L, Carlsen AH, Moth G, Christensen HC, Riddervold IS, Christensen MB. Patient motives for contacting out-of-hours care in Denmark: a cross-sectional study. BMC Emerg Med 2020; 20:20. [PMID: 32183705 PMCID: PMC7079359 DOI: 10.1186/s12873-020-00312-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 02/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients in need of acute health care do not always contact the most suitable health care service provider. Contacting out-of-hours primary care for an urgent problem may delay care, whereas contacting emergency medical services for a non-urgent problem could ultimately affect patient safety. More insight into patient motives for contacting a specific health care provider may help optimise patient flows. This study aims to explore patient motives for contacting out-of-hours primary care and the emergency medical services in Denmark. METHODS We conducted a cross-sectional observational study by sending a questionnaire to patients contacting out-of-hours primary care and emergency medical services, both of which can be directly contacted by patients, in two of five Danish regions in 2015. As we aimed to focus on the first access point, the emergency department was not included. The questionnaire included items on patient characteristics, health problem and 26 pre-defined motives. Descriptive analyses of patient characteristics and motives were conducted, stratified by the two health care service providers. Factors associated with contacting each of the two service providers were explored in a modified Poisson regression analysis, and adjusted risk ratios were calculated. RESULTS Three key motives for contacting the two service providers were identified: 'unpleasant symptoms', 'perceived need for prompt action' and 'perceived most suitable health care provider'. Other important motives were 'need arose outside office hours' and 'wanted to talk to a physician' (out-of-hours primary care) and 'expected need for ambulance' and 'worried' (emergency medical services). Higher probability of contacting the emergency medical services versus out-of-hours primary care was seen for most motives relating to own assessment and expectations, previous experience and knowledge, and own needs and wishes. Lower probability was seen for most motives relating to perceived barriers and benefits. CONCLUSIONS Patient motives for contacting the two health care service providers were partly overlapping. The study contributes with new knowledge on the complex decision-making process of patients in need of acute health care. This knowledge could help optimise existing health care services, such as patient safety and the service level, without increasing health care costs.
Collapse
Affiliation(s)
- Linda Huibers
- Research Unit for General Practice, Bartholins Alle 2, 8000, Aarhus, Denmark.
| | - Anders H Carlsen
- Research Unit for General Practice, Bartholins Alle 2, 8000, Aarhus, Denmark
| | - Grete Moth
- Research Unit for General Practice, Bartholins Alle 2, 8000, Aarhus, Denmark
| | - Helle C Christensen
- Emergency Medical Services, Telegrafvej 5, 2750, Ballerup, Denmark.,Danish Clinical Quality Program (RKKP), Frederiksberg Hospital, Ndr. Fasanvej 57, 2000, Frederiksberg, Denmark
| | - Ingunn S Riddervold
- Prehospital Emergency Medical Services, Central Denmark Region, Olof Palmes Allé 34, 8200, Aarhus, N, Denmark
| | | |
Collapse
|
20
|
Viejo-Moreno R, Cabrejas-Aparicio A, Arriero-Fernández N, Quintana-Díaz M, Galván-Roncero E, Gálvez-Marco MDLN, Carriedo-Scher C, Balaguer-Recena J, Marian-Crespo C. Mobile Intensive Care Unit versus Hospital walk-in patients, in the treatment of first episode ST- elevation myocardial infarction. Eur J Intern Med 2020; 73:83-89. [PMID: 31874804 DOI: 10.1016/j.ejim.2019.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/13/2019] [Accepted: 12/15/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the impact of the attention given by emergency medical services teams working in mobile intensive care units (MICU) versus patients arriving at the hospital under their own means with ST-elevation myocardial infarction (STEMI) event in terms of time to reperfusion (TR), mortality at 30 days and six months. METHODS We retrospectively studied 634 consecutive patients with STEMI who underwent primary a percutaneous coronary intervention from January 1st 2015 to December 31st 2018 in a single centre. Depending on the first medical contact patients were classified into two groups, MICU versus walk-in patients. We extracted data on patients' characteristics, symptoms, treatments, times to reperfusion and mortality. RESULTS In our study 634 patients were included, of whom 59.0% were initially attended by the MICU. Differences were seen between the two groups in time delays to the first medical contact (120.0 vs 63.0 min; p < 0.001) and TR (208.0 Vs 150.0 min; p < 0.001). Patients attended by the MICUs presented a shorter ICU and hospital stay. The lowest 30-day mortality rate was observed in MICU group: 9.0% in contrast with 4.5%, p = 0.03; remaining after 6 months. The multivariable analysis showed that the initial attention given by MICU to STEMI patients was a protective agent against mortality [OR: 0.32 (0.11-0.90); p = 0.03]. CONCLUSION Initial attention of the patients with STEMI by doctor-on-board-MICU and available 24 h a day 7 days a week as part of a regional network (CORECAM), was associated with a decrease in the ischemia time, hospital stay and mortality of these patients in our environment.
Collapse
Affiliation(s)
- Rubén Viejo-Moreno
- Movil intensive care unit, Gerencia de Urgencias, Emergencias y Transporte Sanitario (GUETS-SESCAM), Castilla la Mancha, España; Intensive care unit, Hospital Universitario Guadalajara, SESCAM. Guadalajara, España.
| | - Alberto Cabrejas-Aparicio
- Movil intensive care unit, Gerencia de Urgencias, Emergencias y Transporte Sanitario (GUETS-SESCAM), Castilla la Mancha, España
| | | | | | - Enrique Galván-Roncero
- Movil intensive care unit, Gerencia de Urgencias, Emergencias y Transporte Sanitario (GUETS-SESCAM), Castilla la Mancha, España
| | - María de Las Nieves Gálvez-Marco
- Movil intensive care unit, Gerencia de Urgencias, Emergencias y Transporte Sanitario (GUETS-SESCAM), Castilla la Mancha, España.
| | - Cristina Carriedo-Scher
- Movil intensive care unit, Gerencia de Urgencias, Emergencias y Transporte Sanitario (GUETS-SESCAM), Castilla la Mancha, España.
| | | | - Carlos Marian-Crespo
- Intensive care unit, Hospital Universitario Guadalajara, SESCAM. Guadalajara, España.
| |
Collapse
|
21
|
Søvsø MB, Huibers L, Bech BH, Christensen HC, Christensen MB, Christensen EF. Acute care pathways for patients calling the out-of-hours services. BMC Health Serv Res 2020; 20:146. [PMID: 32106846 PMCID: PMC7045402 DOI: 10.1186/s12913-020-4994-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/14/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In Western countries, patients with acute illness or injury out-of-hours (OOH) can call either emergency medical services (EMS) for emergencies or primary care services (OOH-PC) in less urgent situations. Callers initially choose which service to contact; whether this choice reflect the intended differences in urgency and severity is unknown. Hospital diagnoses and admission rates following an OOH service contact could elucidate this. We aimed to investigate and compare the prevalence of patient contacts, subsequent hospital contacts, and the age-related pattern of hospital diagnoses following an out-of-hours contact to EMS or OOH-PC services in Denmark. METHODS Population-based observational cohort study including patients from two Danish regions with contact to EMS or OOH-PC in 2016. Hospital contacts were defined as short (< 24 h) or admissions (≥24 h) on the date of OOH service contact. Both regions have EMS, whereas the North Denmark Region has a general practitioner cooperative (GPC) as OOH-PC service and the Capital Region of Copenhagen the Medical Helpline 1813 (MH-1813), together representing all Danish OOH service types. Calling an OOH service is mandatory prior to a hospital contact outside office hours. RESULTS OOH-PC handled 91% (1,107,297) of all contacts (1,219,963). Subsequent hospital contacts were most frequent for EMS contacts (46-54%) followed by MH-1813 (41%) and GPC contacts (9%). EMS had more admissions (52-56%) than OOH-PC. For both EMS and OOH-PC, short hospital contacts often concerned injuries (32-63%) and non-specific diagnoses (20-45%). The proportion of circulatory disease was almost twice as large following EMS (13-17%) compared to OOH-PC (7-9%) in admitted patients, whereas respiratory diseases (11-14%), injuries (15-22%) and non-specific symptoms (22-29%) were more equally distributed. Generally, admitted patients were older. CONCLUSIONS EMS contacts were fewer, but with a higher percentage of hospital contacts, admissions and prevalence of circulatory diseases compared to OOH-PC, perhaps indicating that patients more often contact EMS in case of severe disease. However, hospital diagnoses only elucidate severity of diseases to some extent, and other measures of severity could be considered in future studies. Moreover, the socio-demographic pattern of patients calling OOH needs exploration as this may play an important role in choice of entrance.
Collapse
Affiliation(s)
- Morten Breinholt Søvsø
- Department of Clinical Medicine, Centre for Prehospital and Emergency Research, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Linda Huibers
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Bodil Hammer Bech
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark
| | | | | | - Erika Frischknecht Christensen
- Department of Clinical Medicine, Centre for Prehospital and Emergency Research, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
| |
Collapse
|
22
|
Lindskou TA, Mikkelsen S, Christensen EF, Hansen PA, Jørgensen G, Hendriksen OM, Kirkegaard H, Berlac PA, Søvsø MB. The Danish prehospital emergency healthcare system and research possibilities. Scand J Trauma Resusc Emerg Med 2019; 27:100. [PMID: 31684982 PMCID: PMC6829955 DOI: 10.1186/s13049-019-0676-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/02/2019] [Indexed: 11/10/2022] Open
Abstract
The emergency medical healthcare system outside hospital varies greatly across the globe - even within the western world. Within the last ten years, the demand for emergency medical service systems has increased, and the Danish emergency medical service system has undergone major changes.Therefore, we aimed to provide an updated description of the current Danish prehospital medical healthcare system.Since 2007, Denmark has been divided into five regions each responsible for health services, including the prehospital services. Each region may contract their own ambulance service providers. The Danish emergency medical services in general include ambulances, rapid response vehicles, mobile emergency care units and helicopter emergency medical services. All calls to the national emergency number, 1-1-2, are answered by the police, or the Copenhagen fire brigade, and since 2011 forwarded to an Emergency Medical Coordination Centre when the call relates to medical issues. At the Emergency Medical Coordination Centre, healthcare personnel assess the situation guided by the Danish Index for Emergency Care and determine the level of urgency of the situation, while technical personnel dispatch the appropriate medical emergency vehicles. In Denmark, all healthcare services, including emergency medical services are publicly funded and free of charge. In addition to emergency calls, other medical services are available for less urgent health problems around the clock. Prehospital personnel have since 2015 utilized a nationwide electronic prehospital medical record. The use of this prehospital medical record combined with Denmark's extensive registries, linkable by the unique civil registration number, enables new and unique possibilities to do high quality prehospital research, with complete patient follow-up.
Collapse
Affiliation(s)
- Tim Alex Lindskou
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000, Aalborg, Denmark.
| | - Søren Mikkelsen
- Department of Regional Health Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000, Odense, Denmark
| | - Erika Frischknecht Christensen
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000, Aalborg, Denmark
| | - Poul Anders Hansen
- Emergency Medical Services, North Denmark Region, Hjulmagervej 20, 9000, Aalborg, Denmark
| | - Gitte Jørgensen
- The Prehospital Organisation, The Region of Southern Denmark, Damhaven 12, 7100, Vejle, Denmark
| | - Ole Mazur Hendriksen
- Prehospital Emergency Medical Services, Region Zealand, Fælledvej 1, 4200, Slagelse, Denmark
| | - Hans Kirkegaard
- Department of Research and Development, Emergency Medical Services, Olof Palmes Alle 34, 8200, Aarhus N, Central Denmark Region, Denmark
| | - Peter Anthony Berlac
- Copenhagen Emergency Medical Services, Telegrafvej 5, 2. stairway, 3. floor, 2750, Ballerup, Denmark
| | - Morten Breinholt Søvsø
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000, Aalborg, Denmark
| |
Collapse
|
23
|
Helicopter Emergency Medical Service (HEMS) Response in Rural Areas in Poland: Retrospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091532. [PMID: 31052200 PMCID: PMC6539897 DOI: 10.3390/ijerph16091532] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/25/2019] [Accepted: 04/30/2019] [Indexed: 01/07/2023]
Abstract
The aim of the study was to identify the characteristics of missions performed by HEMS (Helicopter Emergency Medical Service) crews and the analysis of health problems, which are the most common cause of intervention in rural areas in Poland. The study was conducted using a retrospective analysis based on the medical records of patients provided by the HEMS crew, who were present for the emergencies in rural areas in the period from January 2011 to December 2018. The final analysis included 37,085 cases of intervention by HEMS crews, which accounted for 54.91% of all the missions carried out in the study period. The majority (67.4%) of patients rescued were male, and just under a quarter of those rescued were aged between 50-64 years. Injuries (51.04%) and cardiovascular diseases (36.49%) were the main diagnoses found in the study group. Whereas injuries were significantly higher in the male group and patients below 64 years of age, cardiovascular diseases were higher in women and elderly patients (p < 0.001). Moreover, in the group of women myocardial infarction was significantly more frequent (30.95%) than men, while in the group of men head injuries (27.10%), multiple and multi-organ injuries (25.93%), sudden cardiac arrest (14.52%), stroke (12.19%), and epilepsy (4.95%) was significantly higher. Factors that are associated with the most common health problems of rural patients are: gender and age, as well as the seasons of the year and the values of the Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), and National Advisory Committee for Aeronautics (NACA) used to assess the clinical status of patients.
Collapse
|
24
|
Søvsø MB, Kløjgaard TA, Hansen PA, Christensen EF. Repeated ambulance use is associated with chronic diseases - a population-based historic cohort study of patients' symptoms and diagnoses. Scand J Trauma Resusc Emerg Med 2019; 27:46. [PMID: 30992042 PMCID: PMC6469091 DOI: 10.1186/s13049-019-0624-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/28/2019] [Indexed: 11/23/2022] Open
Abstract
Background There is a growing demand for emergency medical services (EMS) and patients are repeatedly transported by ambulance services. For many patients, especially those with chronic disease, there may be better ways of delivering care. We examined the symptom at time of emergency call and the hospital diagnosis for those ambulance users who repeatedly received an ambulance. Methods Population-based historic cohort study of patients receiving an ambulance after an emergency call between 2011 and 2014: one-time users (i.e. one ambulance run in any 12 month period) were compared to two-time users (two runs in any 12 month period) and frequent users (>two runs). The presenting symptom according to the Danish Index for Emergency Care from the EMS calls and the hospital ICD-10 discharge diagnoses were obtained from patient records. Results We included 52 533 patients (65 932 emergency ambulance runs). Repeated users constituted 16% of the patients (two-time users 11% and frequent users 5%) and one third of all ambulance runs. The symptoms showing the largest increase in frequency with increasing ambulance use were breathing difficulty (N = 3 905–15% were frequent users); seizure (N = 2 437–10% were frequent users), chest pain (N = 7 616–17% were frequent users), and alcohol intoxication (N = 1 998–5% were frequent users). The hospital diagnoses with a corresponding increase were respiratory diseases (N = 4 381) - 13% were frequent users), mental disorders (predominately abuse of alcohol) (N = 3 087–10% were frequent users) and neurological diseases (predominately epilepsy) (N = 2 207–6% were frequent users). 5% of one-time users, 12% of two-time users and 16% of frequent users had a Charlson Comorbidity Index > = 3. Conclusion Repeated use of ambulance services was common and associated with chronic health problems such as chronic respiratory diseases, epilepsy, mental disorders with alcohol abuse and comorbidity. Alternative methods of caring for many of these patients should be considered. Trial registration None. Electronic supplementary material The online version of this article (10.1186/s13049-019-0624-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Morten Breinholt Søvsø
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000, Aalborg, Denmark.
| | - Torben Anders Kløjgaard
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000, Aalborg, Denmark
| | | | - Erika Frischknecht Christensen
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000, Aalborg, Denmark
| |
Collapse
|
25
|
Use of pre-hospital emergency medical services in urban and rural municipalities over a 10 year period: an observational study based on routinely collected dispatch data. Scand J Trauma Resusc Emerg Med 2019; 27:35. [PMID: 30940157 PMCID: PMC6444540 DOI: 10.1186/s13049-019-0607-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pre-hospital emergency medical services (EMS) are an integral part of emergency medical care. EMS planning can be achieved by analyzing patterns of use. However, long-term time trends of EMS use have rarely been studied. The objective of this retrospective study was to investigate utilization patterns over a ten year period, and to compare utilization trends between urban and rural municipalities and between events with and without prehospital emergency physician (PEP) dispatch. METHODS Routine data collected by 26 dispatch centers in the federal state of Bavaria, Germany, from 2007 to 2016 was analyzed. Emergency locations were classified into five levels of rurality. Negative binomial mixed effects regression models were fitted to predict emergency rates and to investigate differences in rates and utilization trends. Graphical representation methods were used to compare distribution of transport rates and distribution across daytime and weekday. RESULTS Twelve million two hundred thousand one hundred fifty-five dispatches assigned to 7,725,636 single emergencies were included. The mean number of emergencies per year and 1000 population (emergency rate) was 42.8 (±16.0) in rural municipalities and 80.7 (±9.3) in large cities. Compared to rural municipalities, cities had higher emergency rates without (IRR = 3.0, CI 2.2-4.0) and with pre-hospital physicians (IRR = 1.5, CI 1.2-2.0). Between 2007 and 2016, the absolute number of emergencies increased by 49.1%. Estimated annual percent change of emergency rates without physician activation ranged from 5.7% (CI 4.3-7.1) in cities to 7.8% (CI 7.6-7.9) in rural areas. Changes in emergency rates with physician attendance were lower, with estimated increases between 1.3 and 2.4%. The average proportion of patients transported to a hospital was lower in cities and remained unchanged. There were no considerable differences or changes in the distribution across daytime and weekdays. CONCLUSION Differences between cities and other areas suggest that the planning of EMS should be targeted to regional characteristics. A substantial increase in emergency rates was observed across all areas of Bavaria, but did not impact transport rates or temporal distributions. Further research is needed to better understand the urgency of emergency events and reasons behind increasing EMS utilization.
Collapse
|
26
|
Rees N, Porter A, Rapport F, Hughes S, John A. Paramedics' perceptions of the care they provide to people who self-harm: A qualitative study using evolved grounded theory methodology. PLoS One 2018; 13:e0205813. [PMID: 30332480 PMCID: PMC6192640 DOI: 10.1371/journal.pone.0205813] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 10/02/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Self-harm (SH) accounts for over 5% of the workload of emergency ambulance services, and therefore Paramedics are often the first health professional in contact with people who SH. The authors of this paper have reported elsewhere the significant gaps in our understandings which exist surrounding this early care interaction, and some of the challenges paramedics and opportunities in paramedic care for people who SH. This study aimed to explore paramedics' perceptions of caring for those who SH using Evolved Grounded Theory Methodology. METHODS This study took place between 2014-2016 in one UK ambulance service covering a population of three million people. Semi structured interviews were conducted, purposively sampling paramedics until saturation was reached. Interviews were recorded, transcribed verbatim, and coded through open, axial, and selective levels of coding, identifying the Basic Social Process (BSP) and developing a Grounded Theory. A second researcher (SH) independently reviewed early results, which were also member-checked with participants. RESULTS Eleven paramedics were interviewed. The following six categories emerged: Context; Judgements and values; Isolation and system failure; Managing risk; Competence at the boundary of mental and physical health needs; Professional, legal and ethical tensions. The BSP Decision making in a context of risk was identified. The final Grounded Theory that emerged was one of 'Wicked Complexity of paramedic care for people who SH, which includes usual factors such as tiredness and frequent callers, heightened factors including lack of support and pathways, and factors specific to SH such assessing mental health and suicide risk. CONCLUSIONS This study builds on a very small body of literature to have explored paramedic care for people who SH and has found that this care interaction provides uniquely complex challenges. The multiple influences within the categories defined in this study need considering conjointly when making improvements to care.
Collapse
Affiliation(s)
- Nigel Rees
- Pre Hospital Emergency Research Unit (PERU), Institute of Life Sciences, Swansea University, Swansea, Wales, United Kingdom
| | - Alison Porter
- Institute of Life Sciences, Swansea University Medical School, Swansea, Wales, United Kingdom
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Sarah Hughes
- Abertawe Bro Morgannwg University Health Board, Princess of Wales Hospital, Bridgend, Wales, United Kingdom
| | - Ann John
- Farr Institute, Swansea University Medical School, Swansea, Wales, United Kingdom
| |
Collapse
|
27
|
Søvsø MB, Hermansen SB, Færk E, Lindskou TA, Ludwig M, Møller JM, Jonciauskiene J, Christensen EF. Diagnosis and mortality of emergency department patients in the North Denmark region. BMC Health Serv Res 2018; 18:548. [PMID: 30001720 PMCID: PMC6044093 DOI: 10.1186/s12913-018-3361-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 07/05/2018] [Indexed: 01/05/2023] Open
Abstract
Background Emergency departments handle a large proportion of acute patients. In 2007, it was recommended centralizing the Danish healthcare system and establishing emergency departments as the main common entrance for emergency patients. Since this reorganization, few studies describing the emergency patient population in this new setting have been carried out and none describing diagnoses and mortality. Hence, we aimed to investigate diagnoses and 1- and 30-day mortality of patients in the emergency departments in the North Denmark Region during 2014–2016. Methods Population-based historic cohort study in the North Denmark Region (580,000 inhabitants) of patients with contact to emergency departments during 2014–2016. The study included patients who were referred by general practitioners (daytime and out-of-hours), by emergency medical services or who were self-referred. Primary diagnoses (ICD-10) were retrieved from the regional Patient Administrative System. For non-specific diagnoses (ICD-10 chapter ‘Symptoms and signs’ and ‘Other factors’), we searched the same hospital stay for a specific diagnosis and used this, if one was given. We performed descriptive analysis reporting distribution and frequency of diagnoses. Moreover, 1- and 30-day mortality rate estimates were performed using the Kaplan-Meier estimator. Results We included 290,590 patient contacts corresponding to 166 ED visits per 1000 inhabitants per year. The three most frequent ICD-10 chapters used were ‘Injuries and poisoning’ (38.3% n = 111,274), ‘Symptoms and signs’ (16.1% n = 46,852) and ‘Other factors’ (14.52% n = 42,195). Mortality at day 30 (95% confidence intervals) for these chapters were 0.86% (0.81–0.92), 3.95% (3.78–4.13) and 2.84% (2.69–3.00), respectively. The highest 30-day mortality were within chapters ‘Neoplasms’ (14.22% (12.07–16.72)), ‘Endocrine diseases’ (8.95% (8.21–9.75)) and ‘Respiratory diseases’ (8.44% (8.02–8.88)). Conclusions Patients in contact with the emergency department receive a wide range of diagnoses within all chapters of ICD-10, and one third of the diagnoses given are non-specific. Within the non-specific chapters, we found a 30-day mortality, surpassing several of the more organ specific ICD-10 chapters. Trial registration Observational study - no trial registration was performed. Electronic supplementary material The online version of this article (10.1186/s12913-018-3361-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Morten Breinholt Søvsø
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000, Aalborg, Denmark.
| | - Sabina Bay Hermansen
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000, Aalborg, Denmark
| | - Emil Færk
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000, Aalborg, Denmark
| | - Tim Alex Lindskou
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000, Aalborg, Denmark
| | - Marc Ludwig
- Emergency Department Hjørring, North Denmark Regional Hospital, Hjørring, Denmark
| | - Jørn Munkhof Møller
- Emergency Department & Trauma Centre, Aalborg University Hospital, Aalborg, Denmark
| | | | - Erika Frischknecht Christensen
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000, Aalborg, Denmark.,Department of Anaesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
28
|
Friesgaard KD, Riddervold IS, Kirkegaard H, Christensen EF, Nikolajsen L. Acute pain in the prehospital setting: a register-based study of 41.241 patients. Scand J Trauma Resusc Emerg Med 2018; 26:53. [PMID: 29970130 PMCID: PMC6029421 DOI: 10.1186/s13049-018-0521-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 06/15/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Acute pain is a frequent symptom, but little is known about the frequency and causes of acute pain in the prehospital population. The objectives of this study were to investigate the frequency of moderate to severe pain among prehospital patients and the underlying causes according to primary hospital diagnose codes. METHODS This was a register-based study on 41.241 patients transported by ambulance. Information on moderate to severe pain [Numeric Rating Scale (NRS, 0-10) > 3 or moderate pain or higher on 4-point likert scale] was extracted from a national electronic prehospital patient record. Patient information was merged with primary hospital diagnose codes based on the 10th version of the International Classification of Diseases (ICD-10) to investigate underlying causes of pain. RESULTS 11.430 patients (27.7%) reported moderate to severe pain during ambulance transport. As a measure of opioid demanding acute pain, 3.275 of 41.241 patients (7.9%) were treated with intravenous fentanyl. Underlying causes of pain were heterogenic according to ICD-10 chapters with injuries being the largest group of patients with moderate to severe pain (XIX: 42.8% of 8.041 patients), followed by non-specific diagnoses (XVIII: 28.5% of 7.101 patients and XXI: 31.6% of 5.148 patients), diseases of the circulatory system (IX: 22.1% of 4.812 patients) and other (20.3% of 16.139 miscellaneous patients). DISCUSSION Due to the high frequency of moderate to severe pain affecting a wide range of patients, more attention on acute pain is necessary. Whether ambulance personnel have sufficient options for treating various pain conditions might be a subject of future evaluation. Non-specific diagnoses accounted for surprisingly many patients with moderate to severe pain, of which many were treated with intravenous fentanyl. This may be substance of further investigation. CONCLUSIONS Moderate to severe pain is a highly frequent and probably underestimated symptom among patients transported by ambulance. Underlying causes of pain are heterogenic as described by primary hospital diagnose codes. More focus on the treatment of acute pain is needed.
Collapse
Affiliation(s)
- Kristian D. Friesgaard
- Research Department, Prehospital Emergency Medical Service, Central Denmark Region, Aarhus, Denmark
- Department of Anesthesiology, Regional Hospital of Horsens, Horsens, Denmark
| | - Ingunn S. Riddervold
- Research Department, Prehospital Emergency Medical Service, Central Denmark Region, Aarhus, Denmark
| | - Hans Kirkegaard
- Research Department, Prehospital Emergency Medical Service, Central Denmark Region, Aarhus, Denmark
| | - Erika F. Christensen
- Department of Clinical Medicine, Center for Prehospital and Emergency Research, Aalborg University, Aalborg, Denmark
- Department of Anesthesiology and Intensive Care, Emergency Clinic Aalborg University Hospital, Aalborg, Denmark
- Prehospital Emergency Medical Services, North Denmark Region, Aalborg, Denmark
| | - Lone Nikolajsen
- Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
29
|
Raatiniemi L, Brattebø G. The challenge of ambulance missions to patients not in need of emergency medical care. Acta Anaesthesiol Scand 2018. [PMID: 29520763 DOI: 10.1111/aas.13103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L. Raatiniemi
- Centre for Pre-Hospital Emergency Care; Oulu University Hospital; Oulu Finland
- Anaesthesia Research Group; MRC, Oulu University Hospital and University of Oulu; Oulu Finland
| | - G. Brattebø
- Department of Anaesthesia & Intensive Care; Haukeland University Hospital; Bergen Norway
- Norwegian National Advisory Unit on Trauma; Division of Emergencies and Critical Care; Oslo University Hospital; Oslo Norway
| |
Collapse
|