Characteristics of Frequent Users of Emergency Medical Services in Singapore

Kuek, Benjamin; Li, Huihua; Yap, Swee Peng; Ng, Marie Xin Ru; Ng, Yih Yng; White, Alexander E.; Ong, Marcus Eng Hock

doi:10.1080/10903127.2018.1484969

Cited by 18 publications

(15 citation statements)

References 31 publications

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“…EDs in Ontario and British Columbia were compared on flow measures for adults and children but did not consider frequent users of EDs [25]. Other studies have examined a single ED or jurisdiction to describe [26,27] or compare [28][29][30] frequent users to other groups. In our study, the Ontario groups had higher acuity than the Alberta groups.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, discharged HSUs in Alberta had about the same mean LOS as discharged controls whereas discharged HSUs in Ontario had a mean LOS about 12 min longer than discharged controls. A study in an urban ED in Ottawa, Ontario showed that 261 highly frequent ED users (patients in the 99th percentile during 2014) with 3164 presentations had a median LOS of 5.2 h (Q1, Q3 3.1, 8.7) [26] and a study in a Singapore ED showed that 243 frequent users (≥4 presentations in 2015) with 1705 presentations had a median LOS of 2h54min (Q1, Q3 1h42min, 5 h) [27] but neither study compare this measure to non-frequent users. These highly frequent ED users had longer median LOS than either of the HSU groups in our study and Ontario HSUs had about the same median as the Singapore frequent users.…”

Section: Discussionmentioning

confidence: 99%

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Frequent users of emergency departments and patient flow in Alberta and Ontario, Canada: an administrative data study

Chen

Fielding

et al. 2020

BMC Health Serv Res

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Background This paper describes and compares patient flow characteristics of adult high system users (HSUs) and control groups in Alberta and Ontario emergency departments (EDs), Canada. Methods Annual cohorts of HSUs were created by identifying patients who made up the top 10% of ED users (by count of ED presentations) in the National Ambulatory Care Reporting System during 2011–2016. Random samples of patients not in the HSU groups were selected as controls. Presentation (e.g., acuity) and ED times (e.g., time to physician initial assessment [PIA], length of stay) data were extracted and described. The length of stay for 2015/2016 data was decomposed into stages and Cox models compared time between stages. Results There were 20,343,230 and 18,222,969 ED presentations made by 7,032,655 and 1,923,462 individuals in the control and HSU groups, respectively. The Ontario groups had higher acuity than the Alberta groups: about 20% in the Ontario groups were from the emergent level whereas Alberta had 11–15%. Time to PIA was similar across provinces and groups (medians of 60 min to 67 min). Lengths of stay were longest for Ontario HSUs (median = 3 h) and shortest for Alberta HSUs (median = 2.2 h). HSUs had shorter times to PIA (hazard ratio [HR] = 1.03; 95% confidence interval [CI] 1.02,1.03), longer times from PIA to decision (HR = 0.84; 95%CI 0.84,0.84), and longer times from decision to leaving the ED (HR = 0.91; 95%CI 0.91,0.91). Conclusions Ontario HSUs had higher acuity and longer ED lengths of stay than the other groups. In both provinces, HSU had shorter times to PIA and longer times after assessment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Frequent users of emergency departments and patient flow in Alberta and Ontario, Canada: an administrative data study

Chen

Fielding

et al. 2020

BMC Health Serv Res

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“…The use of prehospital services was therefore not signi cantly determined by the number of inhabitants, but rather other factors played a dominant role. Speci c infrastructural institutions such as nursing homes, where elderly and multimorbid people usually lived, were found almost exclusively in cities and call for emergency services more frequently [41,42,43,44,45]. The anonymity of the city, with the missing support of the family and neighborhood, and the population's increased expectations also caused the number of operations to rise rapidly [46,47].…”

Section: Urban-rural Distributionmentioning

confidence: 99%

“…In urban areas are also more vulnerable population groups (e.g. homeless people), who often presented themselves as frequent users of emergency services [42,45,48,49,50,51].…”

Section: Urban-rural Distributionmentioning

confidence: 99%

Outpatient Care in Acute and Prehospital Emergency Medicine by Emergency Medical and Patient Transport Service Over a 10-year Period: A Retrospective Study Based on Dispatch Data From a German Emergency Medical Control Center (OFF-RESCUE)

Schehadat

Scherer²,

Groneberg

et al. 2020

Preprint

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Background The number of operations by the German emergency medical service almost doubled between 1994 and 2016. The associated expenses increased by 380 % in a similar period. Operations with treatment on-site, which retrospectively proved to be misallocated (OFF-Missions), have a substantial proportion of the assignment of the emergency medical service (EMS). Besides OFF-Missions, operations with patient transport play a dominant role (named as ON-Missions). The aim of this study is to work out the medical and economic relevance of both operation types.Methods This analysis examined N=819,780 missions of the EMS and patient transport service (PTS) in the catchment area of the emergency medical control center (EMCC) Bad Kreuznach over the period from 01/01/2007 to 12/31/2016 in terms of triage and disposition, urban-rural distribution, duration of operations and economic relevance (p<.01).Results 53.4 % of ON-Missions are triaged with the indication non-life-threatening patient transport; however, 63.7 % are processed by the devices of the EMS. Within the OFF-Mission cohort, 78.2 % and 85.8 % are triaged or dispatched for the EMS. 74 % of all ON-Missions are located in urban areas, 26 % in rural areas; 81.3 % of rural operations are performed by the EMS. 66 % of OFF-Missions are in cities. 93.2 % of the remaining 34 % of operations in rural locations are also performed by the EMS. The odds for both ON- and OFF-Missions in rural areas are significantly higher than for PTS (ORON 3.6, 95 % CI 3.21-3.30; OROFF 3.18, 95 % CI 3.04-3.32). OFF-Missions last 47.2 minutes (SD 42.3; CI 46.9-47.4), while ON-Missions are processed after 79.7 minutes on average (SD 47.6; CI 79.6-79.9). ON-Missions generated a turnover of more than € 114 million, while OFF-Missions made a loss of almost € 13 million.Conclusions This study particularly highlights the increasing utilization of emergency devices; especially in OFF-Missions, the resources of the EMS have a higher number of operations than PTS. OFF-Missions cause immensely high costs due to misallocations from an economic point of view. Appropriate patient management appears necessary from both medical and economic perspective, which requires multiple solution approaches.

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“…People who call the emergency ambulance service frequently may be experiencing falls, mental health problems, self-harming, misusing substances including alcohol, or living with chronic conditions. They are often vulnerable, lonely, living in poverty and experiencing a lower quality of life than the general population [7, 8, 12–15]. .…”

Section: Introductionmentioning

confidence: 99%

What are emergency ambulance services doing to meet the needs of people who call frequently? A national survey of current practice in the United Kingdom

et al. 2019

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BackgroundEmergency ambulance services are integral to providing a service for those with unplanned urgent and life-threatening health conditions. However, high use of the service by a small minority of patients is a concern. Our objectives were to describe: service-wide and local policies or pathways for people classified as Frequent Caller; call volume; and results of any audit or evaluation.MethodWe conducted a national survey of current practice in ambulance services in relation to the management of people who call the emergency ambulance service frequently using a structured questionnaire for completion by email and telephone interview. We analysed responses using a descriptive and thematic approach.ResultsTwelve of 13 UK ambulance services responded. Most services used nationally agreed definitions for ‘Frequent Caller’, with 600–900 people meeting this classification each month. Service-wide policies were in place, with local variations. Models of care varied from within-service care where calls are flagged in the call centre; contact made with callers; and their General Practitioner (GP) with an aim of discouraging further calls, to case management through cross-service, multi-disciplinary team meetings aiming to resolve callers’ needs. Although data were available related to volume of calls and number of callers meeting the threshold for definition as Frequent Caller, no formal audits or evaluations were reported.ConclusionsAmbulance services are under pressure to meet challenging response times for high acuity patients. Tensions are apparent in the provision of care to patients who have complex needs and call frequently. Multi-disciplinary case management approaches may help to provide appropriate care, and reduce demand on emergency services. However, there is currently inadequate evidence to inform commissioning, policy or practice development.

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Characteristics of Frequent Users of Emergency Medical Services in Singapore

Cited by 18 publications

References 31 publications

Frequent users of emergency departments and patient flow in Alberta and Ontario, Canada: an administrative data study

Frequent users of emergency departments and patient flow in Alberta and Ontario, Canada: an administrative data study

Outpatient Care in Acute and Prehospital Emergency Medicine by Emergency Medical and Patient Transport Service Over a 10-year Period: A Retrospective Study Based on Dispatch Data From a German Emergency Medical Control Center (OFF-RESCUE)

What are emergency ambulance services doing to meet the needs of people who call frequently? A national survey of current practice in the United Kingdom

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