Follow-up and Outcome of Patients Who Decline or Are Denied Transport by EMS

Abstract

Introduction:In recent years, several authors have begun to address the medical and legal risks associated with patients refusing or being refused transport by emergency medical services (EMS) systems. However, data regarding patient outcomes still are lacking.Purpose:The purpose of this study was to determine: 1) why patients are not transported; and 2) the subsequent outcome of these patients.Setting:A busy, suburban, volunteer EMS service with indirect medical control, but no guidelines for non-transport of patients.Methods:A retrospective review of the records of 158 consecutive EMS incidents in which an ambulance was called, but the patient was not transported. Follow-up was attempted by telephone contact with the patient and/or family.Results:Telephone follow-up was established successfully for 93 cases (59%). Of the 93 patients, 60 (64.5%) subsequently sought care from a physician, 15 of whom (25%) later were admitted. The mean hospital stay was 6.6±7.9 days (median=3 days) with a range of 1–30 days. Two were admitted to an intensive care unit (ICU) and two others died. Of the 93 study cases, 43 (46%) involved situations in which the patient refused transport. Paramedics declined transport or mutually agreed not to transport in 50 cases (54%). This latter category accounted for 11 (73%) of the 15 hospitalizations. Ten percent of patients (or their families) stated that they were dissatisfied with the non-transport decisions.Conclusions:Serious, even fatal outcomes were identified in the follow-up of patients not transported by EMS. Although a direct causal relationship was not established within the context of this study, situations in which EMS personnel either denied transport (or mutually agreed with the patient not to transport by ambulance) were twice as likely to result in hospitalization than were those cases in which the patients declined transportation against the advice of the EMS personnel.

Alternatives to Traditional EMS Dispatch and Transport: A Scoping Review of Reported Outcomes

“…• Unplanned medical attention after being seen/relapse EMS calls 17,43,48,49,[58][59][60]68 • Define ideal length of time to follow patients, for example:…”

“…• Patient satisfaction 16,17,25,26,49,51,[57][58][59][60][66][67][68] • Collect by follow-up patient interview. 16,26,51,53 • Patient perception of care received 51,53 • Collect by follow-up patient interview.…”

EMS Provider Determinations of Necessity for Transport and Reimbursement for EMS Response, Medical Care, and Transport: Combined Resource Document for the National Association of EMS Physicians Position Statements

“…In 1992, Zachariah et al 39 reported outcomes of patients who declined or who were denied transport by EMS personnel in Harris County, Texas. In a system without a strict written protocol defining the appropriate criteria for EMS provider decision to not transport, 50 patients were denied transport, and 11 (22%) of those patients subsequently required hospitalization.…”

“…In a system without a strict written protocol defining the appropriate criteria for EMS provider decision to not transport, 50 patients were denied transport, and 11 (22%) of those patients subsequently required hospitalization. 39 In 2001, Pointer et al 40 reported paramedic determinations about medical necessity in Alameda County, California, when using a set of written guidelines, and found that 113 of the 1,180 patients in the data set (9.6%) had been undertriaged based on a reference standard of physician determination that the patient should be transported directly to the emergency department (ED). In 2003, Gratton et al 41 reported paramedic determinations of medical necessity in Kansas City, Missouri, where paramedics used a structured, five-item screening form.…”

Evaluating the Impact of an Educational Intervention on Documentation of Decision‐making Capacity in an Emergency Medical Services System

“…Admission rates to the hospital following patient-initiated refusal of EMS transport range from 6% to 13%. [1][2][3] Although in some cases it may be safe for patients to refuse transport, 4 the legal risk to providers in inappropriate instances is well documented. 5,6 Prior to allowing a patient to refuse transport, it must be determined whether the patient is capable of making this decision.…”