Emergency department admission and mortality of the non-transported emergency medical service patients: a cohort study from Northern Finland

Abstract

ObjectivesA high number of emergency medical service (EMS) patients are not transported to hospital by ambulance. Various non-transport protocols and guidelines have been implemented by different EMS providers. The present study examines subsequent tertiary care ED and hospital admission and mortality of the patients assessed and not transported by EMS in Northern Finland and evaluates the factors predicting these outcomes.MethodsData from EMS missions with a registered non-transportation code during 1 January 2018–31 December 2018 were screened retrospectively. EMS charts were retrieved from a local EMS database and data concerning hospital admission and mortality were collected from the medical records of Oulu University Hospital, Oulu, Finland.ResultsA total of 12 530 EMS non-transport missions were included. Of those, a total of 344 (2.7%) patients were admitted to tertiary care ED in 48 hours after the EMS contact, and 229 (1.8%) of them were further admitted to the hospital. Patients with the dispatch code ‘abdominal pain’, clinical presentation with fever or hyperglycaemia, physician phone consultation and a decision not to transport during night hours were associated with a higher risk of ED admission within 48 hours after EMS contact. Overall 48-hour and 30-day mortalities of non-transported patients were 0.2% (n=25) and 1.0% (n=128), respectively.ConclusionIn this cohort, the rate of subsequent tertiary care ED admission and mortality in the non-transported EMS patients was low. Dispatch code abdominal pain, clinical presentation with fever or hyperglycaemia, physician phone consultation and night-hours increased the risk of ED admission within 48 hours after EMS contact.

Ambulance deployment without transport - A retrospective difference analysis for the description of emergency interventions without patient transport in Bavaria

“…al. researched that ambulance personnel are usually able to safely assess patients at the scene when there is no patient transport [29].…”

Pathways for older patients in acute situations and involved actors' experiences of decision-making in ambulatory care

“…The level-of-care decisions of ambulance personnel regarding patients of all ages with severe conditions have been described as appropriate in the majority of situations and potentially inappropriate in approximately 10% of situations (115). The need for ED visits after non-conveyance increased for patients of all ages with symptoms of abdominal pain, fever, hypoglycaemia or when an ambulance assignment was carried out at night (116). The risk of mortality among patients of all ages who were non-conveyed has been described as low (0.2%-0.7%) (116,117) but higher than compared with those discharged from EDs (112,113).…”

“…The need for ED visits after non-conveyance increased for patients of all ages with symptoms of abdominal pain, fever, hypoglycaemia or when an ambulance assignment was carried out at night (116). The risk of mortality among patients of all ages who were non-conveyed has been described as low (0.2%-0.7%) (116,117) but higher than compared with those discharged from EDs (112,113). Older patients with symptoms of infections or mental disorders showed a higher 24hours mortality than younger patients (76).…”

“…In the UK, collaboration in acute situations between ambulance personnel and GPs at PHC centres occurred in 8% of telephone calls to EMCCs (249). In Finland, ambulance personnel contacted GPs by phone during decisions of non-conveyance in around 50% of cases (116).…”

“…Ökad risk för diffusa symtom vid akutsjukdom bland äldre patienter kan vara en förklaring till varför undertriagering sker. Mortalitetsrisken för patienter i alla åldrar som 'ej medföljer' har bedömts vara låg, dvs 0.2% (116), detta är dock högre än för de patienter som skrivs hem från akutmottagningar (112,113). Det finns dock ett flertal orsaker till att patienter inte medföljer till sjukhus vilket försvårar jämförelsen med de som skrivs hem från akutmottagningar (112,117).…”