Inappropriate use and unmet need in paramedic and nonparamedic ambulance systems

Rademaker, Alfred; Powell, Douglas; Read, John

doi:10.1016/s0196-0644(87)80684-4

Cited by 52 publications

(21 citation statements)

References 10 publications

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“…S tudies in several countries have shown the rate of unnecessary emergency ambulance call out and subsequent attendance at accident and emergency departments to be between 11% to 52%. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] This contributes to inefficient, clinically inappropriate health care, and may delay the provision of emergency care to those with life threatening needs. 16 However, research evidence is lacking about the potential impact and acceptability of alternatives to immediate emergency ambulance despatch.…”

Section: Discussionmentioning

confidence: 99%

Computer assisted assessment and advice for "non-serious" 999 ambulance service callers: the potential impact on ambulance despatch

Dale

Higgins²,

Williams³

et al. 2003

Emergency Medicine Journal

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Objective: To investigate the potential impact for ambulance services of telephone assessment and triage for callers who present with non-serious problems (Category C calls) as classified by ambulance service call takers. Design: Pragmatic controlled trial. Calls identified using priority dispatch protocols as non-serious were allocated to intervention and control groups according to time of call. Ambulance dispatch occurred according to existing procedures. During intervention sessions, nurses or paramedics within the control room used a computerised decision support system to provide telephone assessment, triage and, if appropriate, offer advice to permit estimation of the potential impact on ambulance dispatch. Setting: Ambulance services in London and the West Midlands. Subjects: Patients for whom emergency calls were made to the ambulance services between April 1998 and May 1999 during four hour sessions sampled across all days of the week between 0700 and 2300. Main outcome measures: Triage decision, ambulance cancellation, attendance at an emergency department. Results: In total, there were 635 intervention calls and 611 controls. Of those in the intervention group, 330 (52.0%) were triaged as not requiring an emergency ambulance, and 119 (36.6%) of these did not attend an emergency department. This compares with 55 (18.1%) of those triaged by a nurse or paramedic as requiring an ambulance (odds ratio 2.62; 95% CI 1.78 to 3.85). Patients triaged as not requiring an emergency ambulance were less likely to be admitted to an inpatient bed (odds ratio 0.55; 95% CI 0.33 to 0.93), but even so 30 (9.2%) were admitted. Nurses were more likely than paramedics to triage calls into the groups classified as not requiring an ambulance. After controlling for age, case mix, time of day, day of week, season, and ambulance service, the results of a logistic regression analysis revealed that this difference was significant with an odds ratio for nurses:paramedics of 1.28 (95% CI 1.12 to 1.47). Conclusions:The findings indicate that telephone assessment of Category C calls identifies patients who are less likely to require emergency department care and that this could have a significant impact on emergency ambulance dispatch rates. Nurses were more likely than paramedics to assess calls as requiring an alternative response to emergency ambulance despatch, but the extent to which this relates to aspects of training and professional perspective is unclear. However, consideration should be given to the acceptability, reliability, and cost consequences of this intervention before it can be recommended for full evaluation. S tudies in several countries have shown the rate of unnecessary emergency ambulance call out and subsequent attendance at accident and emergency departments to be between 11% to 52%. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] This contributes to inefficient, clinically inappropriate health care, and may delay the provision of emergency care to those with life threatening needs. 16 However, research e...

show abstract

Section: Discussionmentioning

confidence: 99%

Computer assisted assessment and advice for "non-serious" 999 ambulance service callers: the potential impact on ambulance despatch

Dale

Higgins²,

Williams³

et al. 2003

Emergency Medicine Journal

View full text Add to dashboard Cite

show abstract

“…In emergency medical services (EMS), there are widespread reports of unnecessary ambulance utilization from the United States, [1][2][3][4] South Africa, 5 Canada, 6 and the United Kingdom, where authors have estimated that between one-third and one-half of all ambulance transports are medically unnecessary. [7][8][9][10][11][12] In 2001, the National Association of EMS Physicians (NAEMSP) recognized that nontransport decisions may be initiated by patients or by EMS personnel, 13 and that "transportation by alternate means or to an alternate destination may be appropriate" for nonurgent patients.…”

Section: Introductionmentioning

confidence: 99%

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

Millin

Brown²,

Schwartz

2011

Prehospital Emergency Care

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With increasing demands for emergency medical services (EMS), many EMS jurisdictions are utilizing EMS providerinitiated nontransport policies as a method to offload potentially nonemergent patients from the EMS system. EMS provider determination of medical necessity, resulting in nontransport of patients, has the potential to avert unnecessary emergency department visits. However, EMS systems that utilize these policies must have additional education for the providers, a quality improvement process, and active physician oversight. In addition, EMS provider determination of nontransport for a specific situation should be supported by evidence in the peer-reviewed literature that the practice is safe. Further, EMS systems that do not utilize these programs should not be financially penalized. Payment for EMS services should be based on the prudent layperson standard. EMS systems that do utilize nontransport policies should be appropriately reimbursed, as this represents potential cost savings to the health care system.

show abstract

“…1 Between 11% and 52% of emergency ambulance call outs are to patients with non-serious problems. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Excessive demand may lead to delays in the arrival of ambulances to those with life threatening needs, potentially contributing to avoidable morbidity and mortality. 16 There is limited evidence about the impact and acceptability of alternatives to immediate emergency ambulance despatch.…”

mentioning

confidence: 99%

Safety of telephone consultation for "non-serious" emergency ambulance service patients

Dale

2004

Quality and Safety in Health Care

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Inappropriate use and unmet need in paramedic and nonparamedic ambulance systems

Cited by 52 publications

References 10 publications

Computer assisted assessment and advice for "non-serious" 999 ambulance service callers: the potential impact on ambulance despatch

Computer assisted assessment and advice for "non-serious" 999 ambulance service callers: the potential impact on ambulance despatch

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

Safety of telephone consultation for "non-serious" emergency ambulance service patients

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