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Granlund L, Brännström I, Lindström V. Factors influencing non-conveyance care encounters in the ambulance service, registered nurses experiences - a qualitative study. BMC Nurs 2024; 23:271. [PMID: 38658953 PMCID: PMC11044363 DOI: 10.1186/s12912-024-01899-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/28/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND There is a notable variation in the percentage of non-conveyed patients within the ambulance service. Discharging patients at the scene includes a risk of adverse events, and both patients and ambulance clinicians experience the complexity of non-conveyance. Therefore, this study aimed to describe factors influencing the care encounter when care in the ambulance service concludes with non-conveyance. METHOD A qualitative study design employing the critical incident technique for data collection through individual interviews, and a qualitative analysis based on Fridlund et al. descriptions was utilized. The study conforms to the COREQ checklist for reporting qualitative research. RESULTS Fourteen Registered Nurses (RN) described 30 incidents and various factors were identified as influencing the care encounter. The factors included communication, sharing information, maintaining a secure and confident approach, organizational aspects, applying person-centered care in collaboration with the patient, relatives, and other caregivers, and an overall understanding of the patient's entire situation. These factors were integrated into the RNs' decision-making process for non-conveyance. CONCLUSION The decision-making process for non-conveyance by RNs is a multifaceted approach that incorporates several factors. Communication, sharing of information, maintaining a secure and confident approach, organizational aspects, applying person-centered care in collaboration with the patient, relatives, and other caregivers, and a comprehensive understanding of the patient's entire situation. These findings have the potential to contribute to the development of guidelines supporting the RNs working in the ambulance service in their decisions regarding non-conveyance. Further research is needed on the patient's and relatives' perspective on non-conveyance otherwise, patient participation and partnership in person-centered care are not possible to achieve.
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Affiliation(s)
- L Granlund
- Department of Ambulance Service, Region Västerbotten, Umeå, Sweden
| | - I Brännström
- Department of Ambulance Service, Region Västerbotten, Umeå, Sweden
| | - V Lindström
- Department of Nursing, Umeå University, Umeå, Sweden.
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Abstract
BACKGROUND Older patients are often vulnerable and highly dependent on healthcare professionals' assessment in the event of acute illness. In the context of ambulance services, this poses challenges as the assessment is normally conducted with a focus on identifying life-threatening conditions. Such assessment is not fully satisfactory in a patient relationship that also aims to promote and protect patient autonomy. AIM To describe ambulance clinicians' understanding of older patients' self-determination when the patient's decision-making ability is impaired. RESEARCH DESIGN A qualitative design with an inductive approach, guided by descriptive phenomenology. PARTICIPANTS In total, 30 ambulance clinicians, comprised of 25 prehospital emergency nurses, 1 nurse and 4 emergency medical technicians participated in 15 dyadic interviews. ETHICAL CONSIDERATIONS The research was conducted in accordance with the Declaration of Helsinki, and permission was granted by the Swedish Ethical Review Authority. FINDINGS The findings are presented in two themes: (1) Movement between explicit and implicit will; and (2) Contradictions about the patient's best interests. The clinicians' interpretations are based on an understanding of the patient's situation using substitute decision-making in emergency situations and conversations that reveal the patient's explicit wishes. Sometimes the clinicians collaborate to validate the patient's implicit will, while they at other times subordinate themselves to others' opinions. The clinicians find themselves in conflict between personal values and organisational values as they try to protect the patient's self-determination. CONCLUSION The results indicate that older patients with an impaired decision-making ability risk losing the right to self-determination in the context of ambulance services. The clinicians face challenges that significantly affect their ability to handle the older patient's unique needs based on a holistic perspective and their ability to be autonomous.
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Carnicelli A, Williams AMM, Edwards DG. Paramedic Education and Training for the Management of Patients Presenting with Low-Acuity Clinical Conditions: A Scoping Review. Healthcare (Basel) 2024; 12:176. [PMID: 38255066 PMCID: PMC10815047 DOI: 10.3390/healthcare12020176] [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: 10/01/2023] [Revised: 12/03/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Ambulance services around the world are increasingly attending to calls for non-emergency conditions. These lower-acuity conditions do not always require patients to be transported to the emergency department. Consequently, over the past two decades, ambulance services have implemented strategies to support paramedics in diverting non-urgent patients to alternative care pathways. However, assessing and managing low-acuity conditions can be challenging for paramedics, especially when education and training has traditionally focussed on emergency care. This scoping review explores the education and training provided to paramedics on low-acuity clinical conditions and the use of alternative care pathways. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was applied. The databases searched included Scopus, CINAHL, Embase, Emcare, and MEDLINE (PubMed). The search identified one-hundred sixty-six records, with a total of nine articles reviewed after the removal of duplicates and the screening process. The articles were diverse, with education and training ranging from university degrees for extended care practitioners to short in-service-based training for a suite of protocols or assessment tools. However, the literature addressing education and training on low-acuity conditions and alternative care pathways is limited, with the type and length of education programs appearing to influence practice. There is a need for further research to establish a low acuity education model.
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Affiliation(s)
- Anthony Carnicelli
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS 7000, Australia; (A.-M.M.W.); (D.G.E.)
| | - Anne-Marie M. Williams
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS 7000, Australia; (A.-M.M.W.); (D.G.E.)
| | - Dale G. Edwards
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS 7000, Australia; (A.-M.M.W.); (D.G.E.)
- Clinical Services, Ambulance Tasmania, Cambridge, TAS 7170, Australia
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Ort BBA, Uit Het Broek LG, de Bruin H, Akkermans RP, Goosselink B, Vermeulen H, Ebben RHA, Vloet LCM, Berben SAA. Patient factors associated with conveyance decision-making by Emergency Medical Services professionals in patients with a syncope: a cross-sectional factorial survey design. BMC Emerg Med 2023; 23:118. [PMID: 37798716 PMCID: PMC10557231 DOI: 10.1186/s12873-023-00890-y] [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: 04/05/2023] [Accepted: 09/29/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The clinical decision-making of non-conveyance is perceived as complex and difficult by emergency medical services (EMS) professionals. Patients with a transient loss of consciousness (TLOC) based on syncope constitute a significant part of the non-conveyance population. Risk stratification is the basis of the clinical decision-making process by EMS professionals. This risk stratification is based on various patient factors. This study aimed to explore patient factors significantly associated with conveyance decision-making by EMS professionals in patients with a TLOC based on syncope. METHODS A cross-sectional vignette study with a factorial survey design was conducted. Patient factors were derived from the "National Protocol Ambulance Care", and all possible combinations of these factors and underlying categories were combined, resulting in 256 unique vignettes (2*4*4*4*2 = 256). Patient factors presented either low-risk or high-risk factors for adverse events. Data were collected through an online questionnaire, in which participants received a random sample of 15 vignettes. For each vignette, the respondent indicated whether the patient would need to be conveyed to the emergency department or not. A multilevel logistic regression analysis with stepwise backward elimination was performed to analyse factors significantly associated with conveyance decision-making. In the logistic model, we modelled the probability of non-conveyance. RESULTS 110 respondents were included, with 1646 vignettes being assessed. Mean age 45.5 (SD 9.3), male gender 63.6%, and years of experience 13.2 (SD 8.9). Multilevel analysis showed two patient factors contributing significantly to conveyance decision-making: 'red flags' and 'prehospital electrocardiogram (ECG)'. Of these patient factors, three underlying categories were significantly associated with non-conveyance: 'sudden cardiac death < 40 years of age in family history' (OR 0.33, 95% CI 0.22-0.50; p < 0.001), 'cardiovascular abnormalities, pulmonary embolism or pulmonary hypertension in the medical history' (OR 0.62, 95% CI 0.43-0.91; p = 0.01), and 'abnormal prehospital ECG' (OR 0.54, 95% CI 0.41-0.72; p < 0.001). CONCLUSION Sudden cardiac death < 40 years of age in family history, medical history, and abnormal ECG are significantly negatively associated with non-conveyance decision-making by EMS professionals in patients with a TLOC based on syncope. Low-risk factors do not play a significant role in conveyance decision-making.
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Affiliation(s)
- B Bastiaan A Ort
- School of Health Studies, Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands.
| | - Lucia G Uit Het Broek
- School of Health Studies, Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Harm de Bruin
- Emergency Medical Service, RAV Utrecht, Utrecht, The Netherlands
| | - Reinier P Akkermans
- Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud University Medical Centre , Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ben Goosselink
- Emergency Medical Service, Ambulance IJsselland, Zwolle, The Netherlands
| | - Hester Vermeulen
- Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud University Medical Centre , Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Remco H A Ebben
- School of Health Studies, Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Emergency Medical Service, Public Health and Safety region Gelderland-Midden, Arnhem, The Netherlands
| | - Lilian C M Vloet
- School of Health Studies, Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud University Medical Centre , Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Sivera A A Berben
- School of Health Studies, Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud University Medical Centre , Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
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Wilson C, Janes G, Lawton R, Benn J. Types and effects of feedback for emergency ambulance staff: a systematic mixed studies review and meta-analysis. BMJ Qual Saf 2023; 32:573-588. [PMID: 37028937 PMCID: PMC10512001 DOI: 10.1136/bmjqs-2022-015634] [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: 10/12/2022] [Accepted: 03/13/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Extensive research has been conducted into the effects of feedback interventions within many areas of healthcare, but prehospital emergency care has been relatively neglected. Exploratory work suggests that enhancing feedback and follow-up to emergency medical service (EMS) staff might provide staff with closure and improve clinical performance. Our aim was to summarise the literature on the types of feedback received by EMS professionals and its effects on the quality and safety of patient care, staff well-being and professional development. METHODS A systematic review and meta-analysis, including primary research studies of any method published in peer-reviewed journals. Studies were included if they contained information on systematic feedback to emergency ambulance staff regarding their performance. Databases searched from inception were MEDLINE, Embase, AMED, PsycINFO, HMIC, CINAHL and Web of Science, with searches last updated on 2 August 2022. Study quality was appraised using the Mixed Methods Appraisal Tool. Data analysis followed a convergent integrated design involving simultaneous narrative synthesis and random effects multilevel meta-analyses. RESULTS The search strategy yielded 3183 articles, with 48 studies meeting inclusion criteria after title/abstract screening and full-text review. Interventions were categorised as audit and feedback (n=31), peer-to-peer feedback (n=3), postevent debriefing (n=2), incident-prompted feedback (n=1), patient outcome feedback (n=1) or a combination thereof (n=4). Feedback was found to have a moderate positive effect on quality of care and professional development with a pooled effect of d=0.50 (95% CI 0.34, 0.67). Feedback to EMS professionals had large effects in improving documentation (d=0.73 (0.00, 1.45)) and protocol adherence (d=0.68 (0.12, 1.24)), as well as small effects in enhancing cardiac arrest performance (d=0.46 (0.06, 0.86)), clinical decision-making (d=0.47 (0.23, 0.72)), ambulance times (d=0.43 (0.12, 0.74)) and survival rates (d=0.22 (0.11, 0.33)). The between-study heterogeneity variance was estimated at σ2=0.32 (95% CI 0.22, 0.50), with an I2 value of 99% (95% CI 98%, 99%), indicating substantial statistical heterogeneity. CONCLUSION This review demonstrated that the evidence base currently does not support a clear single point estimate of the pooled effect of feedback to EMS staff as a single intervention type due to study heterogeneity. Further research is needed to provide guidance and frameworks supporting better design and evaluation of feedback interventions within EMS. PROSPERO REGISTRATION NUMBER CRD42020162600.
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Affiliation(s)
- Caitlin Wilson
- School of Psychology, University of Leeds, Leeds, UK
- Research and Development Department, Yorkshire Ambulance Service NHS Trust, Wakefield, UK
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | - Gillian Janes
- Department of Nursing, Manchester Metropolitan University, Manchester, UK
| | - Rebecca Lawton
- School of Psychology, University of Leeds, Leeds, UK
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | - Jonathan Benn
- School of Psychology, University of Leeds, Leeds, UK
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
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Nielsen VML, Lindskou TA, Weinreich UM, Jespersen MS, Christensen EF, Bøggild H. Decision on non-conveyance of patients suspected of COVID-19 in a novel arrangement with assessment visits by paramedics at home. BMC Emerg Med 2023; 23:56. [PMID: 37237344 DOI: 10.1186/s12873-023-00826-6] [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: 09/30/2022] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND During the first weeks of the outbreak of the coronavirus disease 2019 (COVID-19), the North Denmark emergency medical services authorised paramedics to assess patients suspected of COVID-19 at home, and then decide if conveyance to a hospital was required. The aim of this study was to describe the cohort of patients who were assessed at home and their outcomes in terms of subsequent hospital visits and short-term mortality. METHODS This was a historical cohort study in the North Denmark Region with consecutive inclusion of patients suspected of COVID-19 who were referred to a paramedic's assessment visit by their general practitioner or an out-of-hours general practitioner. The study was conducted from 16 March to 20 May 2020. The outcomes were the proportion of non-conveyed patients who subsequently visited a hospital within 72 hours of the paramedic's assessment visit and mortality at 3, 7 and 30 days. Mortality was estimated using a Poisson regression model with robust variance estimation. RESULTS During the study period, 587 patients with a median age of 75 (IQR 59-84) years were referred to a paramedic's assessment visit. Three of four patients (76.5%, 95% CI 72.8;79.9) were non-conveyed, and 13.1% (95% CI 10.2;16.6) of the non-conveyed patients were subsequently referred to a hospital within 72 hours of the paramedic's assessment visit. Within 30 days from the paramedic's assessment visit, mortality was 11.1% [95% CI 6.9;17.9] among patients directly conveyed to a hospital and 5.8% [95% CI 4.0;8.5] among non-conveyed patients. Medical record review revealed that deaths in the non-conveyed group had happened among patients with 'do-not-resuscitate' orders, palliative care plans, severe comorbidities, age ≥ 90 years or nursing home residents. CONCLUSIONS The majority (87%) of the non-conveyed patients did not visit a hospital for the following three days after a paramedic's assessment visit. The study implies that this newly established prehospital arrangement served as a kind of gatekeeper for the region's hospitals in regard to patients suspected of COVID-19. The study also demonstrates that implementation of non-conveyance protocols should be accompanied by careful and regular evaluation to ensure patient safety.
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Affiliation(s)
- Vibe Maria Laden Nielsen
- Centre for Prehospital and Emergency Research, Aalborg University Hospital, Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Tim Alex Lindskou
- Centre for Prehospital and Emergency Research, Aalborg University Hospital, Aalborg, Denmark
| | - Ulla Møller Weinreich
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark
| | | | - Erika Frischknecht Christensen
- Centre for Prehospital and Emergency Research, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Prehospital Emergency Services, North Denmark Region, Aalborg, Denmark
| | - Henrik Bøggild
- Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Lederman J, Löfvenmark C, Djärv T, Lindström V, Elmqvist C. A phenomenological interview study with patients being non-conveyed in the ambulance service. BMC Emerg Med 2023; 23:30. [PMID: 36927353 PMCID: PMC10021955 DOI: 10.1186/s12873-023-00797-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/22/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Non-conveyed patients (i.e. patients who are not transported to a hospital after being assessed by ambulance clinicians) represent a significantly increasing proportion of all patients seeking ambulance care. Scientific knowledge about patients' non-conveyance experiences is sparse. This study describes the lived experiences of non-conveyed patients in an ambulance care context. METHODS A reflective lifeworld research (RLR) approach founded on phenomenology is used. Data is derived from nine in-depth interviews with patients not conveyed by the ambulance service in a major Swedish region. RESULTS Patients' lived experiences of becoming acutely ill or injured and not conveyed by ambulance to a hospital are characterised by several dynamic movements: losing and regaining situational and bodily control, dependence and autonomy, external competence and inner knowledge, handing over and regaining responsibility, and fear and security. CONCLUSIONS Patients' lived experiences of non-conveyance are complex and versatile. Although non-conveyed patients initially experience strong fear and the loss of situational and bodily control, they gradually feel more secure when experiencing confirmation and trust, which evolves into insecurity and uncertainty. The non-conveyance situation's complexity from a patient's perspective implies the need for ambulance organisations to take measures to prevent further suffering. Non-conveyed patients must be taken seriously in their unique situations, requiring ambulance clinicians to reflect and act with a conscious ethical perspective before, during and after their visit.
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Affiliation(s)
- Jakob Lederman
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
- Academic Emergency Medical Services/AISAB Ambulance care in Greater Stockholm Ltd, Region Stockholm, Sweden.
| | - Caroline Löfvenmark
- Department of Health promoting science, Sophiahemmet University, Stockholm, Sweden
| | - Therese Djärv
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Veronica Lindström
- Department of Neurobiology, Care Sciences and Society, section of nursing, Karolinska Institutet, Stockholm, Sweden
- Samariten Ambulance, Stockholm, Sweden
| | - Carina Elmqvist
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
- Centre of Interprofessional Cooperation within Emergency care (CICE), Linnaeus University, Växjö, Sweden
- Department of Research and Development, Region Kronoberg, Växjö, Sweden
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Wallin K, Bremer A, Fridlund B, Hörberg U, Werkander Harstäde C. The ways specialist nursing students understand the work in the ambulance service - a national Swedish phenomenographic study. Int J Qual Stud Health Well-being 2022; 17:2099023. [PMID: 35799452 PMCID: PMC9272920 DOI: 10.1080/17482631.2022.2099023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Objective Design, sample, and measurements Findings Conclusions
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Affiliation(s)
- Kim Wallin
- Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University, Vaxjo, Sweden
- Faculty of Health and Life Sciences, Linnaeus University, Vaxjo, Sweden
| | - Anders Bremer
- Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University, Vaxjo, Sweden
- Faculty of Health and Life Sciences, Linnaeus University, Vaxjo, Sweden
| | - Bengt Fridlund
- Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University, Vaxjo, Sweden
| | - Ulrica Hörberg
- Faculty of Health and Life Sciences, Linnaeus University, Vaxjo, Sweden
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Hjalmarsson A, Östlund G, Asp M, Kerstis B, Holmberg M. A matter of participation? A critical incident study of municipal care personnel in situations involving care-dependent older persons and emergency medical services. Int J Qual Stud Health Well-being 2022; 17:2082062. [PMID: 35703409 PMCID: PMC9225717 DOI: 10.1080/17482631.2022.2082062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Purpose This study aimed at describing municipal care personnel’s experiences of and actions in situations when older persons need emergency medical services (EMS) at home. Methods An inductive descriptive design adhering to critical incident technique (CIT) was used. Data were collected through interviews and free text written questionnaires, analysed in accordance with CIT procedure. Results Experiences related to the main areas of Lifesaving competence and Collaborative care. Lifesaving competence involved having sufficient knowledge to guide older persons in emergencies without organizational support. The lack of care alternatives carries dependence on inter-organizational collaboration, as well as having to accept the collaborative conditions provided by the EMS. Actions meant Adjusting to situational needs and EMS authority, which involved safeguarding the person while being directed by the EMS. Conclusions Lack of organizational support, care alternatives, and structured collaboration jeopardize care-dependent older persons’ health, and ability to influence care when emergency situations occur at home. Municipal care personnel’s actions as the older person’s representative support human agency, allowing older persons to become active participants in care despite acute suffering. This study underlines the importance of further developing welfare policies that facilitate and regulate inter-organizational responsibilities of health and social care to favour older people.
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Affiliation(s)
- Anna Hjalmarsson
- 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
| | - Margareta Asp
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna Västerås, Sweden
| | - Birgitta Kerstis
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna Västerås, Sweden
| | - Mats Holmberg
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna Västerås, Sweden
- Faculty of Health and Life Sciences, Linneaus University, Växjö, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Ambulance Services, Region Sörmland, Eskilstuna, Sweden
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Noble AJ, Mason SM, Bonnett LJ, Reuber M, Wright J, Pilbery R, Jacques RM, Simpson RM, Campbell R, Fuller A, Marson AG, Dickson JM. Supporting the ambulance service to safely convey fewer patients to hospital by developing a risk prediction tool: Risk of Adverse Outcomes after a Suspected Seizure (RADOSS)-protocol for the mixed-methods observational RADOSS project. BMJ Open 2022; 12:e069156. [PMID: 36375988 PMCID: PMC9668054 DOI: 10.1136/bmjopen-2022-069156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Ambulances services are asked to further reduce avoidable conveyances to emergency departments (EDs). Risk of Adverse Outcomes after a Suspected Seizure seeks to support this by: (1) clarifying the risks of conveyance and non-conveyance, and (2) developing a risk prediction tool for clinicians to use 'on scene' to estimate the benefits an individual would receive if conveyed to ED and risks if not. METHODS AND ANALYSIS Mixed-methods, multi-work package (WP) project. For WP1 and WP2 we shall use an existing linked data set that tracks urgent and emergency care (UEC) use of persons served by one English regional ambulance service. Risk tools are specific to clinical scenarios. We shall use suspected seizures in adults as an exemplar.WP1: Form a cohort of patients cared for a seizure by the service during 2019/2020. It, and nested Knowledge Exchange workshops with clinicians and service users, will allow us to: determine the proportions following conveyance and non-conveyance that die and/or recontact UEC system within 3 (/30) days; quantify the proportion of conveyed incidents resulting in 'avoidable ED attendances' (AA); optimise risk tool development; and develop statistical models that, using information available 'on scene', predict the risk of death/recontact with the UEC system within 3 (/30) days and the likelihood of an attendance at ED resulting in an AA.WP2: Form a cohort of patients cared for a seizure during 2021/2022 to 'temporally' validate the WP1 predictive models.WP3: Complete the 'next steps' workshops with stakeholders. Using nominal group techniques, finalise plans to develop the risk tool for clinical use and its evaluation. ETHICS AND DISSEMINATION WP1a and WP2 will be conducted under database ethical approval (IRAS 307353) and Confidentiality Advisory Group (22/CAG/0019) approval. WP1b and WP3 have approval from the University of Liverpool Central Research Ethics Committee (11450). We shall engage in proactive dissemination and knowledge mobilisation to share findings with stakeholders and maximise evidence usage.
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Affiliation(s)
- Adam J Noble
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Suzanne M Mason
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Laura J Bonnett
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Markus Reuber
- Academic Neurology Unit, The University of Sheffield, Sheffield, UK
| | | | - Richard Pilbery
- Research and Development Department, Yorkshire Ambulance Service NHS Trust, Wakefield, UK
| | - Richard M Jacques
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Rebecca M Simpson
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Richard Campbell
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | | | - Anthony Guy Marson
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Jon Mark Dickson
- Academic Unit of Primary Medical Care, The University of Sheffield, Sheffield, UK
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11
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Ivic R, Vicente V, Kurland L, Svensson J, Sahdev Klintemård R, Castrén M, Bohm K. Pre-hospital emergency nurse specialist's experiences in caring for patients with non-specific chief complaints in the ambulance - A qualitative interview study. Int Emerg Nurs 2022; 63:101178. [PMID: 35738055 DOI: 10.1016/j.ienj.2022.101178] [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: 07/08/2021] [Revised: 04/05/2022] [Accepted: 05/04/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pre-hospital emergency nurse (PEN) specialists are faced with patients presenting with non-specific chief complaints (NSC) to the emergency medical service (EMS) on a daily basis. These patients are often elderly and one in three has a serious condition and their acuity is not recognized. OBJECTIVE The aim of the current study was to explore PEN specialists' experiences in caring for patients presenting with non-specific chief complaints. DESIGN A qualitative study design with eleven individual interviews of PENs, between 2018 and 2020. Qualitative content analysis was used. RESULTS The analyses generated three categories including subcategories. The categories were "Unexplained suffering". "Systematic approach and experience enhances medical safety". "Organizational processes can be optimized". The relation between the categories compiled as ́In-depth systematic assessment is perceived to reduce suffering and increases patient safetý. CONCLUSION The PENs experiences in caring for patients presenting with non-specific chief complaints show that an in-depth systematic assessment may lead to a meaningful caring encounter which enables the identification of the cause of the chief complaint. Experience and a systematic approach were considered as essential to enhance medical safety. This could be strengthened through feedback on the nurse's care provided by care managers and employers. To optimize organizational processes, the development of the opportunity to convey the patient to different levels of care can be an important component.
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Affiliation(s)
- R Ivic
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Academic Emergency Medical Service, Region Stockholm, Stockholm, Sweden.
| | - V Vicente
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.
| | - L Kurland
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Örebro University, Department for Medical Sciences, Örebro, Sweden.
| | | | | | - M Castrén
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Emergency Medicine, Helsinki University and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.
| | - K Bohm
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Department of Emergency Medicine, Södersjukhuset, Stockholm, Sweden.
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12
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Outcomes in patients not conveyed by emergency medical services (EMS): a one-year prospective study. Scand J Trauma Resusc Emerg Med 2022; 30:40. [PMID: 35698086 PMCID: PMC9195370 DOI: 10.1186/s13049-022-01023-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/09/2022] [Indexed: 12/05/2022] Open
Abstract
Background The decision to not convey patients has become common in emergency medical services worldwide. A substantial proportion (12–51%) of the patients seen by emergency medical services are not conveyed by those services. The practice of non-conveyance is a result of the increasing and changing demands on the acute care system. Research focusing on the outcomes of the decision by emergency medical services to not convey patients is needed. Aim The aim was to describe outcomes (emergency department visits, admission to in-hospital intensive care units and mortality, all within seven days) and their association with the variables (sex, age, day of week, time of day, emergency signs and symptoms codes, triage level colour, and destination) for non-conveyed patients. Methods This was a prospective analytical study with consecutive inclusion of all patients not conveyed by emergency medical services. Patients were included between February 2016 and January 2017. The study was conducted in Region Örebro county, Sweden. The region consists of both rural and urban areas and has a population of approximately 295,000. The region had three ambulance departments that received approximately 30,000 assignments per year. Results The result showed that no patient received intensive care, and 18 (0.7%) patients died within seven days after the non-conveyance decision. Older age was associated with a higher risk of hospitalisation and death within seven days after a non-conveyance decision. Conclusions Based on the results of this one-year follow-up study, few patients compared to previous studies were admitted to the hospital, received intensive care or died within seven days. This study contributes insights that can be used to improve non-conveyance guidelines and minimise the risk of patient harm. Supplementary information The online version contains supplementary material available at 10.1186/s13049-022-01023-3.
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13
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Larsson G, Dagerhem A, Wihlborg J, Rantala A. Satisfaction among non-conveyed patients and significant others when discharged at the scene by the ambulance service: an exploratory cross-sectional survey. BMC Emerg Med 2022; 22:100. [PMID: 35672702 PMCID: PMC9171931 DOI: 10.1186/s12873-022-00659-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/27/2022] [Indexed: 11/30/2022] Open
Abstract
Background The ambulance service is facing an increased number of calls and ambulance assignments. Between 12 and 42% of all assignments result in non-conveyance to the Accident and Emergency Department. However, there is limited knowledge regarding satisfaction among patients and significant others when patients are assessed as non-urgent and discharged at the scene. Therefore, the aim of the study was to explore and compare satisfaction with the ambulance service among patients and significant others when the patient was discharged at the scene. Methods The present study was designed as a cross-sectional exploratory survey with a consecutive sample employing the Consumer Emergency Care Satisfaction Scale questionnaire on patients and significant others. Results A total of 162 questionnaires were analysed, 87 patients and 75 significant others. Overall, satisfaction was high with no significant difference between patients and significant others, although 17-19% were dissatisfied with the discharge information. Conclusions Generally, patients and significant others are satisfied with the care provided by the Ambulance Service when discharged at the scene and thus not conveyed the Accident and Emergency Department. The participants were especially satisfied with Specialist Ambulance Nurses’ interpersonal skills, e.g., making time and providing thorough information. Guidelines for assignments involving non-conveyance, as well as information, instructions and what to expect when discharged at the scene can be improved.
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Affiliation(s)
- Glenn Larsson
- PreHospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.,Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alma Dagerhem
- Emergency Department, Halland Hospital, Halmstad, Sweden
| | - Jonas Wihlborg
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Andreas Rantala
- Emergency Department, Helsingborg General Hospital, Helsingborg, Sweden. .,Department of Health Sciences, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden. .,Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University, Växjö, Sweden.
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14
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Conte H, Wihlborg J, Lindström V. Developing new possibilities for interprofessional learning- students' experience of learning together in the ambulance service. BMC MEDICAL EDUCATION 2022; 22:192. [PMID: 35307011 PMCID: PMC8935834 DOI: 10.1186/s12909-022-03251-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 03/11/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND It is known that setting and context matters, and contextual factors influence interprofessional education (IPE). Activities developed in a new setting should therefore be evaluated to determine students' experiences and learning. IPE in the ambulance service may present a new setting for interprofessional learning (IPL). AIM The aim of this study was to explore undergraduate students' experiences of collaboration and learning together during their clinical rotation in the ambulance service. STUDY DESIGN AND METHOD A mixed convergent parallel design was used to describe nursing and medical students' experiences of collaboration and learning together during their clinical rotation in the ambulance service during autumn 2019. Two group interviews with nursing students (n = 20; response rate 80%) were conducted and the medical students (n = 40; response rate 72.5%) answered a self-assessment questionnaire regarding their IPE. The group discussions were analysed using an inductive thematic analysis and descriptive statistics were used to describe the medical students' self-assessed experiences and competencies in interprofessional collaboration. RESULTS In the context of the ambulance service, some of the challenges included, the team vary daily, a context that can be unpredictable, and the team being required to make decisions in various situations with limited support. The context presented good opportunities to learn together, since they faced a broad variety of situations and had opportunities to follow patients through the chain of care. CONCLUSION The students' experiences show that the ambulance service offers possibilities for IPL. The ambulance service enhanced the students' learning in an unfamiliar environment, encouraging them to develop collaborative learning strategies and situational leadership regardless of established hierarchical structures and stereotypes that are sometimes present in other parts of the health care service. ETHICAL APPROVAL By the Swedish Ethical Review Authority. No: 2019-03595.
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Affiliation(s)
- Helen Conte
- Department of Neurobiology, Care Sciences and Society, Division of Nursing Karolinska Institutet, Stockholm, Sweden
| | - Jonas Wihlborg
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Veronica Lindström
- Department of Neurobiology, Care Sciences and Society, Division of Nursing Karolinska Institutet, Stockholm, Sweden.
- Department of Health Promotion, Sophiahemmet University, Stockholm, Sweden.
- Samariten Ambulance Stockholm, Stockholm, Sweden.
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15
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Wilson C, Howell AM, Janes G, Benn J. The role of feedback in emergency ambulance services: a qualitative interview study. BMC Health Serv Res 2022; 22:296. [PMID: 35241068 PMCID: PMC8896262 DOI: 10.1186/s12913-022-07676-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several international studies suggest that the feedback that emergency ambulance service (EMS) personnel receive on the care they have delivered lacks structure, relevance, credibility and routine implementation. Feedback in this context can relate to performance or patient outcomes, can come from a variety of sources and can be sought or imposed. Evidence from health services research and implementation science, suggests that feedback can change professional behavior, improve clinical outcomes and positively influence staff mental health. The current study aimed to explore the experience of EMS professionals regarding current feedback provision and their views on how feedback impacts on patient care, patient safety and staff wellbeing. METHODS This qualitative study was conducted as part of a wider study of work-related wellbeing in EMS professionals. We used purposive sampling to select 24 frontline EMS professionals from one ambulance service in the United Kingdom and conducted semi-structured interviews. The data was analyzed in iterative cycles of inductive and deductive reasoning using Abductive Thematic Network Analysis. The analysis was informed by psychological theory, as well as models from the wider feedback effectiveness and feedback-seeking behavior literature. RESULTS Participants viewed current feedback provision as inadequate and consistently expressed a desire for increased feedback. Reported types of prehospital feedback included patient outcome feedback, patient-experience feedback, peer-to-peer feedback, performance feedback, feedforward: on-scene advice, debriefing and investigations and coroners' reports. Participants raised concerns that inadequate feedback could negatively impact on patient safety by preventing learning from mistakes. Enhancing feedback provision was thought to improve patient care and staff wellbeing by supporting personal and professional development. CONCLUSIONS In line with previous research in this area, this study highlights EMS professionals' strong desire for feedback. The study advances the literature by suggesting a typology of prehospital feedback and presenting a unique insight into the motives for feedback-seeking using psychological theory. A logic model for prehospital feedback interventions was developed to inform future research and development into prehospital feedback.
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Affiliation(s)
- Caitlin Wilson
- School of Psychology, University of Leeds, Leeds, United Kingdom. .,North West Ambulance Service NHS Trust, Bolton, United Kingdom.
| | | | - Gillian Janes
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, United Kingdom
| | - Jonathan Benn
- School of Psychology, University of Leeds, Leeds, United Kingdom.,Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
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16
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Falk AC, Lindström V. Self-reported clinical competence before entering advanced level training in acute and prehospital emergency care among registered nurses in Sweden. Int Emerg Nurs 2022; 61:101146. [DOI: 10.1016/j.ienj.2022.101146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/29/2021] [Accepted: 01/18/2022] [Indexed: 11/27/2022]
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17
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Moafa HN, van Kuijk SMJ, Moukhyer ME, Alqahtani DM, Haak HR. Non-Conveyance Due to Patient-Initiated Refusal in Emergency Medical Services: A Retrospective Population-Based Registry Analysis Study in Riyadh Province, Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179252. [PMID: 34501841 PMCID: PMC8431479 DOI: 10.3390/ijerph18179252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 11/26/2022]
Abstract
This research study aimed to investigate the association between demographic and operational factors and emergency medical services (EMS) missions ending in non-conveyance (NC) due to patient-initiated refusal (PIR). We conducted a retrospective population-based registry study by analyzing 67,620 EMS missions dispatched to the scene during 2018 in the Riyadh province. First, the number and percentages of conveyances statuses were calculated. Then, using crude and adjusted linear and logistic regression analysis, we determined which characteristics were predictors of NC due to PIR. We found that 23,991 (34.4%) of missions ended in NC due to PIR, and 5969 ended in EMS-initiated refusal (8.6%). NC rates due to PIR were higher for women, adults, for missions in Riyadh city, during nighttime, for medical emergencies, and for advanced life support (ALS) crews. We also found the following additional predictors significantly associated with the odds of NC due to PIR in crude regression analyses: age category, geographical location, EMS-shift, time of call, emergency type, and response time. We conclude that the NC rate represents half of all missions for patients requesting EMS, and the rate in Riyadh city has increased compared to previous studies. Most NC cases occur for the highest urgency level of medical emergency type in Riyadh city during the nighttime with ALS crews. NC due to PIR involves younger patients more than elderly, and females more than males. This study’s findings have provided empirical evidence that indicate that conducting further studies involving EMS providers, patients, and the public to identify precise and detailed reasons is required.
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Affiliation(s)
- Hassan N. Moafa
- Department of Health Services Management, Faculty of Public Health and Tropical Medicine, Jazan University, Jazan 82817 2820, Saudi Arabia
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, 6229 GT Maastricht, The Netherlands;
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands;
- Correspondence: or ; Tel.: +31-615-373-733
| | - Sander M. J. van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands;
| | - Mohammed E. Moukhyer
- Department of Academic Development and Quality, Faculty of Applied Medical Sciences, Jazan University, Jazan 82511, Saudi Arabia;
| | - Dhafer M. Alqahtani
- Department of Electronic Transaction Management, Saudi Red Crescent Authority, Ministry of Health, Riyadh 13251-8261, Saudi Arabia;
| | - Harm R. Haak
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, 6229 GT Maastricht, The Netherlands;
- Department of Internal Medicine, Maxima Medisch Centre, 5631 BM Eindhoven, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
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18
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Forsgärde ES, Svensson A, Rööst M, Fridlund B, Elmqvist C. The dialogue as decision support; lived experiences of extended collaboration when an ambulance is called. Int J Qual Stud Health Well-being 2021; 16:1970095. [PMID: 34427535 PMCID: PMC8386744 DOI: 10.1080/17482631.2021.1970095] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Purpose This study aimed to describe extended collaboration in situations when an ambulance was called, as experienced by older patients, a significant other, and ambulance- and primary healthcare (PHC) centre personnel. Methods The study used a phenomenological reflective lifeworld research (RLR) approach. Participants included in three specific situations with extended collaboration were interviewed: three older patients, one significant other, three ambulance personnel and four personnel at the PHC centre. The transcribed interviews were analysed for meanings of the phenomenon. Results The extended collaboration means that decisions were supported through dialogue by bridging knowledge spaces between person, within-team and across-team levels. Through dialogue experience and knowledge were shared and certainty in decisions was increased. The extended collaboration was built on trust, responsibility taken, shared and entrusted, and the common goal of adapted care for the unique patient. A need for further improvement and transparency was elucidated. Conclusions The difficulty of making care decisions stresses the importance of available extended collaboration based on the dialogue between patients, significant others, and ambulance- and PHC centre personnel to increase certainty in decisions. Collaboration further requires respectful encounters, trust, responsibility and a common goal of adapting the care for the unique patient.
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Affiliation(s)
- Elin-Sofie Forsgärde
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.,Centre of Interprofessional Collaboration within Emergency Care CICE, Linnaeus University, Växjö, Sweden
| | - Anders Svensson
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.,Centre of Interprofessional Collaboration within Emergency Care CICE, Linnaeus University, Växjö, Sweden.,Ambulance Service, Region Kronoberg, Växjö, Sweden
| | - Mattias Rööst
- Department for Research and Development, Region Kronoberg, Växjö, Sweden.,Department of Clinical Sciences in Malmö, Family Medicine, Lund University, Malmö, Sweden
| | - Bengt Fridlund
- Centre of Interprofessional Collaboration within Emergency Care CICE, Linnaeus University, Växjö, Sweden
| | - Carina Elmqvist
- Centre of Interprofessional Collaboration within Emergency Care CICE, Linnaeus University, Växjö, Sweden.,Department for Research and Development, Region Kronoberg, Växjö, Sweden
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19
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Vicente V, Johansson A, Selling M, Johansson J, Möller S, Todorova L. Experience of using video support by prehospital emergency care physician in ambulance care - an interview study with prehospital emergency nurses in Sweden. BMC Emerg Med 2021; 21:44. [PMID: 33827436 PMCID: PMC8028766 DOI: 10.1186/s12873-021-00435-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/12/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction When in need of emergency care and ambulance services, the ambulance nurse is often the first point of contact for the patient with healthcare. This role requires comprehensive knowledge of the ambulance nurse to be able to assign the right level of care and, if necessary, to provide self-care advice for patients with no further conveyance to hospital. Recently, an application was developed for transmitting real-time video to facilitate consultation between ambulance nurses and prehospital physicians in the role of regional medical support (RMS) for ambulance care. The use of video communication as a complement of medical support when referring to self-care is still an unexplored method in a prehospital setting. Our study aimed to elucidate ambulance nurses’ experience of video consultation with RMS physician during the assessment of patients considered to be triaged to self-care. Method We conducted a qualitative design study using semi-structured interviews with open questions. Twelve ambulance nurses were included in the study. To explore the ambulance nurses’ experience of performing video consultation with RMS physician, in cases when a patient was assessed and triaged to self-care, a content analysis was performed. Results A main category emerged from the results: “ Video consultation as decision support in the ambulance care promotes increased patient participation and for the ambulance nurses, it creates a feeling of increased patient safety “. The main category was based and formed on the following categories: “ Simultaneous presence of ambulance nurse and a physician increases patient participation during the assessment resulting in a confident care decision “. “Interprofessional collaboration strengthens the medical assessment”. “Video technology promotes accessibility for patients needs in the ambulance care regardless of emergency level”. Conclusions Ambulance nurses experienced that the use of video consultation increases patient involvement and confidence in healthcare when both the ambulance nurse and the physician were present when deciding on self-care advice. The live imaging allowed the ambulance nurse and prehospital physician to reach a consensus on the patient’s current medical care needs, which in turn led to a feeling of increased patient safety for the ambulance nurses.
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Affiliation(s)
- Veronica Vicente
- The Ambulance Medical Service in Stockholm (AISAB), Lindetorpsvägen 11, SE-121 18 Johanneshov, Stockholm, Sweden. .,Academic EMS, Stockholm, Sweden. .,Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset in Stockholm, Stockholm, Sweden.
| | - Anders Johansson
- Office of Medical Services, Region Skåne, Malmö, Sweden.,Department of Clinical Science, Lund University, Region Skåne, Lund, Sweden
| | - Magnus Selling
- Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset in Stockholm, Stockholm, Sweden
| | - Johnny Johansson
- Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset in Stockholm, Stockholm, Sweden
| | - Sebastian Möller
- Office of Medical Services, Region Skåne, Malmö, Sweden.,Department of Clinical Science, Lund University, Region Skåne, Lund, Sweden
| | - Lizbet Todorova
- Office of Medical Services, Region Skåne, Malmö, Sweden.,Department of Clinical Science, Lund University, Region Skåne, Lund, Sweden
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20
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Alternatives to direct emergency department conveyance of ambulance patients: a scoping review of the evidence. Scand J Trauma Resusc Emerg Med 2021; 29:4. [PMID: 33407771 PMCID: PMC7789540 DOI: 10.1186/s13049-020-00821-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/02/2020] [Indexed: 12/02/2022] Open
Abstract
Background The role of ambulance services is shifting, due in part to more intermediate, non-urgent patients who do not require direct emergency department conveyance, yet who cannot be safely left at home alone. Evidence surrounding the safety, effectiveness and efficiency of alternate care routes is not well known. Methods This scoping review sought to identify all studies that examined alternate routes of care for the non-urgent “intermediate” patient, as triaged on scene. Search terms for the sample (ambulances, paramedics, etc.) and intervention (e.g. referrals, alternate care route, non-conveyance) were combined. Articles were systematically searched using four databases and grey literature sources (February 2020). Independent researchers screened title-abstract and full text stages. Results Of 16,037 records, 41 examined alternate routes of care after triage by the on-scene paramedic. Eighteen articles considered quantitative patient data, 12 studies provided qualitative perspectives while 11 were consensus or opinion-based articles. The benefits of alternative schemes are well-recognised by patients, paramedics and stakeholders and there is supporting evidence for a positive impact on patient-centered care and operational efficiency. Challenges to successful use of schemes included: patient safety resulting from incorrect triage decisions, inadequate training, lack of formal partnerships between ambulance and supporting services, and insufficient evidence to support safe implementation or continued use. Studies often inaccurately defined success using proxies for patient safety (e.g. decision comparisons, rates of secondary contact). Finally, patients expressed willingness for such schemes but their preference must be better understood. Conclusions This broad summary offers initial support for alternate routes of care for intermediate, non-urgent patients. Even so, most studies lacked methodologically rigorous evidence and failed to evaluate safe patient outcomes. Some remedies appear to be available such as formal triage pathways, targeted training and organisational support, however there is an urgent need for more research and dissemination in this area.
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21
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Alrazeeni DM. Relationship Between Nonconveyed Cases and On-Scene Time Intervals for Emergency Medical Services. J Multidiscip Healthc 2020; 13:1895-1904. [PMID: 33324069 PMCID: PMC7733405 DOI: 10.2147/jmdh.s279693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/15/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Emergency medical service (EMS) consumption is increasing worldwide. Some EMS cases in Saudi Arabia result in nonconveyance of patients. The aim of the present study was to determine the relationship between nonconveyed EMS cases and on-scene time intervals in Riyadh EMS centers. Methods Nonrandomized retrospective data obtained from EMS providers of nonconveyed emergency cases were gathered and analyzed. Data were taken from the ten busiest EMS centers in Riyadh, Saudi Arabia from January 1 to April 30, 2019. Analyses of means ± SD, bivariate comparisons, multivariate analysis, CI correlations, and regressionwere performed. Results Categories of nonconveyed cases were “Treatment given at the scene” V1 = 66, “Refused by patient/relative” (V2 = 876), “Patient not found” (V3 = 67), “Dead patient” (V4 = 80”, “Other (police, etc)” (V5 = 34), and NA (96). We found highly significant differences (p<0.001) among several categories of nonconveyed cases and on-scene time intervals among EMS centers. Conclusion This study found that there were highly significant differences among several categories of nonconveyed cases in relation to on-scene time intervals for different EMS centers. Results indicated that the probability of nonconveyance decisions was more likely to increase in the categories “Refused by patient/relative,” “Patient not found,” and “Dead patient.” The results did not reveal details of what happened on scene during or after the nonconveyance decision had been made, which needs to be investigated.
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Affiliation(s)
- Daifallah M Alrazeeni
- Academic Affairs, Prince Sultan Bin Abdulaziz College for EMS, King Saud University, Riyadh, Saudi Arabia
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22
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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.
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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
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Forsgärde ES, Elmqvist C, Fridlund B, Svensson A, Andersson R, Rööst M. Patients' aged ≥65 years dispositions during ambulance assignments, including factors associated with non-conveyance to hospital: a longitudinal and comparative study. BMJ Open 2020; 10:e038885. [PMID: 33243795 PMCID: PMC7692831 DOI: 10.1136/bmjopen-2020-038885] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES Patients ≥65 years old represent 30%-50% of all ambulance assignments (AAs), and the knowledge of which care level they are disposed to is limited and diverging. The aim of this study was therefore to describe and compare characteristics of patients' aged ≥65 years dispositions during AA, including determining changes over time and factors associated with non-conveyance to hospitals. DESIGN A longitudinal and comparative database study. SETTING Ambulance service in a Swedish region. PARTICIPANTS 32 085 AAs with patients ≥65 years old during the years 2014, 2016 and 2018. EXCLUSION CRITERIA AAs with interhospital patient transfers and lack of patients' dispositions data. OUTCOME MEASURES Dependent factors: conveyance and non-conveyance to hospitals. Independent factors: age, sex, symptom, triage level, scene, time, day and season. RESULTS The majority (n=29 060; 90.6%) of patients' dispositions during AA were conveyance to hospitals. In total, the most common symptoms were circulatory (n=4953; 15.5%) and respiratory (n=4529; 14.1%). A significant increase, p<0.01, of non-conveyance to hospitals was shown during 2014 and 2018, from 801 (7.8%) to 1295 (11.4%). Increasing age was associated with decreasing odds of non-conveyance, 85-89 years (OR=0.85, 95 % CI=0.72 to 0.99) and 90 years or older (OR=0.80, 95 % CI=0.68 to 0.93). Several factors were associated with non-conveyance, for example, symptoms of diabetes (OR=8.57, 95 % CI=5.99 to 12.26) and mental disorders (OR=5.71, 95 % CI=3.85 to 8.48) in comparison with infections. CONCLUSIONS The study demonstrates several patient characteristics, and factors associated with non-conveyance to hospitals, such as age, symptom, triage level, scene, time, day and season. The increasing non-conveyance trend highlights the importance of further studies on optimal care levels for patients ≥65 years old.
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Affiliation(s)
- Elin-Sofie Forsgärde
- Health and Caring Science, Linnaeus University Faculty of Health and Life Sciences, Växjö, Sweden
- Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University Faculty of Health and Life Sciences, Växjö, Sweden
| | - Carina Elmqvist
- Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University Faculty of Health and Life Sciences, Växjö, Sweden
- Department for Research and Development, Region Kronoberg, Växjö, Sweden
| | - Bengt Fridlund
- Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University Faculty of Health and Life Sciences, Växjö, Sweden
| | - Anders Svensson
- Health and Caring Science, Linnaeus University Faculty of Health and Life Sciences, Växjö, Sweden
- Ambulance Service, Region Kronoberg, Växjö, Sweden
| | | | - Mattias Rööst
- Department for Research and Development, Region Kronoberg, Växjö, Sweden
- Clinical Sciences Malmö, Lund University, Lund, Sweden
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Bremer A, Andersson Hagiwara M, Tavares W, Paakkonen H, Nyström P, Andersson H. Translation and further validation of a global rating scale for the assessment of clinical competence in prehospital emergency care. Nurse Educ Pract 2020; 47:102841. [PMID: 32768897 DOI: 10.1016/j.nepr.2020.102841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 05/30/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
Global rating scales are useful to assess clinical competence at a general level based on specific word dimensions. The aim of this study was to translate and culturally adapt the Paramedic Global Rating Scale, and to contribute validity evidence and instrument usefulness in training results and clinical competence assessments of students undergoing training to become ambulance nurses and paramedics at Swedish and Finnish universities. The study included translation, expert review and inter-rater reliability (IRR) tests. The scale was translated and culturally adapted to clinical and educational settings in both countries. A content validity index (CVI) was calculated using eight experts. IRR tests were performed with five registered nurses working as university lecturers, and with six clinicians working as ambulance nurses. They individually rated the same simulated ambulance assignment. Based on the ratings IRR was calculated with intra-class correlation (ICC). The scale showed excellent CVI for items and scale. The ICC indicated substantial agreement in the group of lecturers and a high degree of agreement in the group of clinicians. This study provides validity evidence for a Swedish version of the scale, supporting its use in measuring clinical competence among students undergoing training to become ambulance nurses and paramedics.
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Affiliation(s)
- Anders Bremer
- PreHospen - Centre for Prehospital Research, University of Borås, Sweden; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden; Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.
| | - Magnus Andersson Hagiwara
- PreHospen - Centre for Prehospital Research, University of Borås, Sweden; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden.
| | - Walter Tavares
- The Wilson Centre, Department of Medicine, University of Toronto/University Health Network, Toronto, Canada; Post-MD Education (Post-Graduate Medical Education/Continued Professional Development), University of Toronto, Toronto, Canada; Paramedic and Senior Services, Community and Health Services Department, Regional Municipality of York, Newmarket, ON, Canada.
| | - Heikki Paakkonen
- Department of Health and Welfare, Arcada University of Applied Sciences, Helsinki, Finland.
| | - Patrik Nyström
- Department of Health and Welfare, Arcada University of Applied Sciences, Helsinki, Finland.
| | - Henrik Andersson
- PreHospen - Centre for Prehospital Research, University of Borås, Sweden; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden.
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25
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Lederman J, Lindström V, Elmqvist C, Löfvenmark C, Djärv T. Non-conveyance in the ambulance service: a population-based cohort study in Stockholm, Sweden. BMJ Open 2020; 10:e036659. [PMID: 32665389 PMCID: PMC7365423 DOI: 10.1136/bmjopen-2019-036659] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Non-conveyed patients represent a significant proportion of all patients cared for by ambulance services in the western world. However, scientific knowledge on non-conveyance is sparse. Therefore, the aim of this study was to describe the prevalence of non-conveyance, investigate associations and compare patients' characteristics, drug administration, initial problems and vital signs between non-conveyed and conveyed patients. DESIGN A population-based retrospective cohort study. SETTING The study setting area, Stockholm, Sweden, has a population of 2.3 million inhabitants, with seven emergency hospitals. Annually, approximately 210 000 assignments are performed by 73 ambulances. All ambulance assignments performed from 1 January to 31 December 2015 were included. RESULTS In total, 23 603 ambulance assignments ended in non-conveyance-13.8% of all ambulance assignments performed in 2015. Compared with conveyed patients, non-conveyed patients were younger and more often female (median age 50.1 years for non-conveyed vs 61.7 years for conveyed; female=52 %, both p values <0.001). Approximately half of all ambulance assignments ending in non-conveyance were initially prioritised and dispatched as the highest priority. Non-conveyed patients were more often assessed by ambulance clinicians as presenting non-specific symptoms or symptoms related to psychiatric problems. Low blood glucose levels were highly associated with non-conveyance (adjusted OR (AOR): 15; 95 % CI 11.18 to 20.13), although non-conveyed patients presented abnormal vital signs across all categories of vital signs. Moreover, drugs were more often administered to younger non-conveyed patients. Older patients were more often conveyed and administered drugs once conveyed (AOR: 1.29; 95 % CI 1.07 to 1.56). CONCLUSIONS This study shows that non-conveyed patients represent a non-negligible proportion of all patients in contact with ambulance services. In general, most cases of non-conveyance occur at the highest dispatch level, to a large extent involve younger patients, and features problems assessed by ambulance clinicians as non-specific or related to psychiatric symptoms.
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Affiliation(s)
- Jakob Lederman
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Academic Emergency Medical Services, Stockholm, Sweden
| | - Veronica Lindström
- Department of Neurobiology, Care Sciences and Society, Section of Nursing, Karolinska Institutet, Stockholm, Sweden
- Samariten Ambulance, Stockholm, Sweden
| | - Carina Elmqvist
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
- Centre of Interprofessional Cooperation within Emergency care, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Caroline Löfvenmark
- Department of Health Promoting Science, Sophiahemmet University College, Stockholm, Sweden
| | - Therese Djärv
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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