Ambulance crew‐initiated non‐conveyance in the Helsinki EMS system—A retrospective cohort study

Heinonen, Kari; Puolakka, Tuukka; Salmi, Heli; Boyd, James; Laiho, Mia; Porthan, K.; Harve‐Rytsälä, Heini; Kuisma, Markku

doi:10.1111/aas.14049

Cited by 19 publications

(17 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The present study showed that >70% of suspected epileptic seizure patients requiring transportation to a hospital were similarly identified by dispatchers and paramedics, a finding that is comparable to or even better than identifying acute stroke [36]. On the other hand, in this study, the nonconveyance rate of 25% was in the lower half of the previously reported 16.3%-45% [10,[13][14][15] and was significantly lower than that of the general EMS population [22]. It has been speculated that a higher proportion would be suitable for home management if paramedics felt appropriately supported [13,37].…”

Section: Economic Burdensupporting

confidence: 61%

See 1 more Smart Citation

Burden of suspected epileptic seizures on emergency services: A population‐based study

Kämppi

Puolakka

Ritvanen

et al. 2023

Euro J of Neurology

Self Cite

View full text Add to dashboard Cite

Background and purpose Patients with acute epileptic seizures form a large patient group in emergency neurology. This study aims to determine the burden caused by suspected epileptic seizures at different steps in emergency care. Methods A retrospective, cross‐sectional, population‐based (>1,000,000 inhabitants), 4‐year (2015–2018) study was conducted in an urban setting with a single dispatch centre, a university hospital‐affiliated emergency medical service (EMS), and five emergency departments (EDs). The study covered all adult (≥16 years old) emergency neurology patients receiving medical attention due to suspected epileptic seizures from the EMS and EDs and during hospital admissions in the Helsinki metropolitan area. Results Epileptic seizures were suspected in 14,364 EMS calls, corresponding to 3.3% of all EMS calls during the study period. 9,112 (63.4%) cases were transported to hospital due to suspected epileptic seizures, and 3368 (23.4%) were discharged on the scene. 6969 individual patients had 11,493 seizure‐related ED visits, accounting for 3.1% of neurology‐ and internal medicine‐related ED visits and 4607 hospital admissions were needed with 3 days’ median length of stay (IQR=4, Range 1‐138). Male predominance was noticeable at all stages (EMS 64.7%, EDs 60.1%, hospital admissions 56.2%). The overall incidence was 333/100,000 inhabitants/year for seizure‐related EMS calls, 266/100,000 inhabitants/year for ED visits and 107/100,000 inhabitants/year for hospital admissions. Total estimated costs were 6.8 million €/year, corresponding to 0.5% of all specialized healthcare costs in the study area. Conclusions Patients with suspected epileptic seizures cause a significant burden on the health care system. Present‐day epidemiological data are paramount when planning resource allocation in emergency services.

show abstract

Section: Economic Burdensupporting

confidence: 61%

“…Patients who are not independent in the activities of daily living or do not meet the abovementioned criteria for seizures are transported to the four other hospital EDs. Ambulance crews can also leave a well-recovering patient on the scene according to the nonconveyance protocol [22].…”

Section: Hospital System and Ems Transport Destinationmentioning

confidence: 99%

Burden of suspected epileptic seizures on emergency services: A population‐based study

Kämppi

Puolakka

Ritvanen

et al. 2023

Euro J of Neurology

Self Cite

View full text Add to dashboard Cite

show abstract

“…Consequently, the quality of patient care relies heavily on factors such as the clinicians’ competence, experience, organizational support, and adherence to guidelines [ 3 , 4 ]. The ambulance assignments have increased over time [ 5 – 7 ] and the non-conveyed patients constitute a significant and expanding proportion (3.7–93.7%) of the total patients attended to and cared for by ambulance services [ 3 , 8 – 10 ]. In care encounters ending with a non-conveyance decision, ambulance clinicians have recognized the complexity of the processes for non-conveyance decisions, involving a balancing act of various expectations and encountering challenges due to limited organizational support [ 11 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

Factors influencing non-conveyance care encounters in the ambulance service, registered nurses experiences - a qualitative study

Granlund,

Brännström,

Lindström

2024

BMC Nurs

View full text Add to dashboard Cite

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.

show abstract

“…Low-acuity conditions include (but are not limited to) soft tissue injuries; minor falls; musculoskeletal back pain; gastroenteritis symptoms; headaches, e.g., migraine; and dizziness or vertigo from benign causes [ 5 ]. In fact, the utilisation by the public of ambulance services for these low-acuity conditions, has been increasing both within Australia and internationally [ 1 , 3 , 4 , 5 , 6 , 7 ]. For example, it was reported by one state ambulance service in Australia that 53% of patients assessed by emergency paramedics were either non-acute (i.e., low acuity) or did not require transport to an ED [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…As a consequence of the growing proportion of low acuity conditions attended to by ambulance services, there is a varying percentage of patients that are deemed to not require transport to hospital [ 3 , 6 , 10 , 11 , 12 , 13 , 14 ]. Whilst many of these patients can safely remain in the community, there is a cohort who still require some form of health or medical care [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Paramedic Education to Support the Use of Low-Acuity Care Pathways: A Scoping Review Protocol

2023

View full text Add to dashboard Cite

Ambulance services worldwide have transformed over time into health care services that not only attend to life-threatening emergencies, but are also increasingly being utilised for patients with low-acuity or non-urgent illness and injury. As a result, there has been a need to adapt and include mechanisms to assist paramedics in the assessment and management of such patients, including alternative pathways of care. However, it has been identified that education and training for paramedics in the care of low-acuity patients is limited. This study aims to identify potential gaps in the literature and inform further research, paramedic education and training, patient care guidelines, and policy. A scoping review will be conducted utilising the Joanna Briggs Institutes methodology. A range of relevant electronic databases will be searched along with the grey literature, using search terms related to paramedic education for low-acuity patient care pathways. The search results will be screened by two authors and presented in the PRISMA-ScR format, with articles presented in tabular format and analysed thematically. The results of this scoping review will inform further research exploring paramedic education, clinical guidelines, policy and experiences in the management of low-acuity patients.

show abstract

Ambulance crew‐initiated non‐conveyance in the Helsinki EMS system—A retrospective cohort study

Cited by 19 publications

References 25 publications

Burden of suspected epileptic seizures on emergency services: A population‐based study

Burden of suspected epileptic seizures on emergency services: A population‐based study

Factors influencing non-conveyance care encounters in the ambulance service, registered nurses experiences - a qualitative study

Paramedic Education to Support the Use of Low-Acuity Care Pathways: A Scoping Review Protocol

Contact Info

Product

Resources

About