Increasing utilisation of emergency ambulances

Lowthian, Judy; Cameron, Peter; Stoelwinder, Johannes Uiltje; Curtis, Andrea J.; Currell, Alex; Cooke, Matthew; McNeil, John J

doi:10.1071/ah09866

Cited by 188 publications

(185 citation statements)

References 29 publications

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“…One review 17 and two primary studies 19,25 only considered older populations. Two studies 16,22 investigated emergency ambulance utilisation, seven focused on ED attendances and one 24 on ED and GP out-of-hours (OOH) attendances. The key common themes that emerged were:…”

Section: Summary Of Findingsmentioning

confidence: 99%

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

Turner

Coster

Chambers

et al. 2015

Health Serv Deliv Res

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BackgroundIn 2013 NHS England set out its strategy for the development of an emergency and urgent care system that is more responsive to patients’ needs, improves outcomes and delivers clinically excellent and safe care. Knowledge about the current evidence base on models for provision of safe and effective urgent care, and the gaps in evidence that need to be addressed, can support this process.ObjectiveThe purpose of the evidence synthesis is to assess the nature and quality of the existing evidence base on delivery of emergency and urgent care services and identify gaps that require further primary research or evidence synthesis.Data sourcesMEDLINE, EMBASE, The Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Web of Science.MethodsWe have conducted a rapid, framework-based, evidence synthesis approach. Five separate reviews linked to themes in the NHS England review were conducted. One general and five theme-specific database searches were conducted for the years 1995–2014. Relevant systematic reviews and additional primary research papers were included and narrative assessment of evidence quality was conducted for each review.ResultsThe review was completed in 6 months. In total, 45 systematic reviews and 102 primary research studies have been included across all five reviews. The key findings for each review are as follows: (1) demand – there is little empirical evidence to explain increases in demand for urgent care; (2) telephone triage – overall, these services provide appropriate and safe decision-making with high patient satisfaction, but the required clinical skill mix and effectiveness in a system is unclear; (3) extended paramedic roles have been implemented in various health settings and appear to be successful at reducing the number of transports to hospital, making safe decisions about the need for transport and delivering acceptable, cost-effective care out of hospital; (4) emergency department (ED) – the evidence on co-location of general practitioner services with EDs indicates that there is potential to improve care. The attempt to summarise the evidence about wider ED operations proved to be too complex and further focused reviews are needed; and (5) there is no empirical evidence to support the design and development of urgent care networks.LimitationsAlthough there is a large body of evidence on relevant interventions, much of it is weak, with only very small numbers of randomised controlled trials identified. Evidence is dominated by single-site studies, many of which were uncontrolled.ConclusionsThe evidence gaps of most relevance to the delivery of services are (1) a requirement for more detailed understanding and mapping of the characteristics of demand to inform service planning; (2) assessment of the current state of urgent care network development and evaluation of the effectiveness of different models; and (3) expanding the current evidence base on existing interventions that are viewed as central to delivery of the NHS England plan by assessing the implications of increasing interventions at scale and measuring costs and system impact. It would be prudent to develop a national picture of existing pilot projects or interventions in development to support decisions about research commissioning.FundingThe National Institute for Health Research Health Services and Delivery Research Programme.

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Section: Summary Of Findingsmentioning

confidence: 99%

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

Turner

Coster

Chambers

et al. 2015

Health Serv Deliv Res

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“…4,5 No obstante, la implantación de este modelo de atención ha venido determinado por un contexto en el que se observa un crecimiento sostenido de las demandas de atención urgente a domicilio que ha oscilado entre el 7 y el 25%. 7 Además, un análisis de los motivos de atención urgente ha puesto de manifiesto que entre el 40 y 50 % de ellos corresponden a demandas inadecuadas o patologías leves no urgentes, siendo los factores socioeconómicos los detonantes de dichas demandas, como son: la edad avanzada, los cambios en las estructuras familiares, la lejanía del domicilio al punto fijo de urgencias y no disponer de vehículo, entre otros; y existe controversia de algunos factores como el sexo. [7][8][9][10] No obstante, se podría matizar que en una reciente revisión de la literatura se observó una amplia variabilidad de criterios para detectar la inadecuación de las demandas, dando lugar a un amplio rango de resultados; si bien se encontró una mediana del 32 % en relación a asistencias inadecuadas.…”

Section: Introductionunclassified

“…7 Además, un análisis de los motivos de atención urgente ha puesto de manifiesto que entre el 40 y 50 % de ellos corresponden a demandas inadecuadas o patologías leves no urgentes, siendo los factores socioeconómicos los detonantes de dichas demandas, como son: la edad avanzada, los cambios en las estructuras familiares, la lejanía del domicilio al punto fijo de urgencias y no disponer de vehículo, entre otros; y existe controversia de algunos factores como el sexo. [7][8][9][10] No obstante, se podría matizar que en una reciente revisión de la literatura se observó una amplia variabilidad de criterios para detectar la inadecuación de las demandas, dando lugar a un amplio rango de resultados; si bien se encontró una mediana del 32 % en relación a asistencias inadecuadas. 11 En España y en el año 2010, los servicios de urgencias extrahospitalarias atendieron 34.9 millones de demandas de atención en todo el país (datos extrapolados a partir de 14 comunidades autónomas), de los que el 3.6 %, es decir, más de 1.25 millones de asistencias correspondieron a demandas de asistencia a domicilio.…”

Section: Introductionunclassified

Actividad y seguridad de la enfermera de urgencias a domicilio para patologías leves

et al. 2014

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Resumen AbstractObjetivos: Explorar la asistencia urgente a domicilio proporcionada por una enfermera sin médico presencial y compararla con la de los equipos con médicos. Metodología: Estudio transversal, con pacientes del Distrito Málaga atendidos por una enfermera de enero 2012 a marzo 2013 y por equipos con médico en 2012. Se hizo un análisis descriptivo, Chi cuadrado y regresiones logísticas multivariantes. Resultados: 641 pacientes atendió la enfermera. Los motivos fueron Cervico-Dorso-Lumbo-ciatalgia (13.9%), Mareos/vértigo (9.5%), Sin patología (8.4%), Hiper/hipotensión arterial (7.8%), etc. Tres pacientes, por hipertensión o agitación, precisaron equipo médico 24 horas después. El equipo médico atendió 7430 motivos similares de 21226 demandas. El incumplimiento y manejo inefectivo del tratamiento se asoció a demandas por dolor no oncológico, hipo/hipertensión e hipo/hiperglucemia. El manejo inefectivo de dispositivos sanitarios y las respuestas inadecuadas de afrontamiento se asociaron a demandas sin patología. Conclusión: La asistencia urgente a domicilio por una enfermera y médico no presencial es segura y eficiente, preámbulo ideal para la práctica avanzada. Palabras clave: Atención Prehospitalaria. Urgencias prehospitalarias. Urgencias extrahospitalarias. Urgencias. Dispositivo de cuidados críticos y urgencias. Enfermera de práctica avanzada. ACTIVITY AND SAFETY OF THE EMERGENCY NURSE ATTENDING MINOR PATHOLOGIES AT HOMEObjetives: To explore the emergency nursing practice at home with a physician on the phone and to compare it with emergency medical teams' activity. Methods: Cross-sectional study, including patients from Málaga District attended by a nurse from January 2012 to March 2013, and by medical teams in 2012. Statistical analysis included descriptive data analysis, Chi-squared test and multivariate logistic regression. Results: 641 patients were attended by the nurse. The causes were: Cervical-Back-sciatica pain (13.9%), dizziness/vertigo (9.5%), No pathology (8.4%), High/Low blood pressure (7.8%), etc. Three patients, with high blood pressure or restlessness, required attention by the medical team 24 hours later. The medical team attended 7,430 similar causes from a 21,226 in total. Noncompliance or ineffective treatment management were associated to non-oncologic pain, high/low blood pressure and hypo/hyperglycaemia. Ineffective management of medical devices and inadequate coping responses were associated to demands without pathology. Conclusion: Emergency nursing practice at home, with a physician on the phone, is safe and efficient, preface of the advanced practice.

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“…3 Escalating growth in demand from emergency patient services has placed increasing strain on both ambulance and hospital resources. 3,4 Negative outcomes, such as ambulance diversion, access block (an ED length of stay (LOS) of >8 h for patients requiring hospital admission 5 ) and increased risk of hospital mortality, as a result of ED and hospital crowding have been reported in Australia and overseas. [5][6][7] Meeting healthcare targets within this environment can be difficult, but is becoming increasingly mandated, monitored and reported upon.…”

Section: Introductionmentioning

confidence: 99%

Expanding emergency department capacity: a multisite study

Crilly

Keijzers

Tippett

et al. 2014

Aust. Health Review

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Objectives. The aims of the present study were to identify predictors of admission and describe outcomes for patients who arrived via ambulance to three Australian public emergency departments (EDs), before and after the opening of 41 additional ED beds within the area.Methods. The present study was a retrospective comparative cohort study using deterministically linked health data collected between 3 September 2006 and 2 September 2008. Data included ambulance offload delay, time to see doctor, ED length of stay (LOS), admission requirement, access block, hospital LOS and in-hospital mortality. Logistic regression analysis was undertaken to identify predictors of hospital admission.Results. Almost one-third of all 286 037 ED presentations were via ambulance (n = 79 196) and 40.3% required admission. After increasing emergency capacity, the only outcome measure to improve was in-hospital mortality. Ambulance offload delay, time to see doctor, ED LOS, admission requirement, access block and hospital LOS did not improve. Strong predictors of admission before and after increased capacity included age >65 years, Australian Triage Scale (ATS) Category 1-3, diagnoses of circulatory or respiratory conditions and ED LOS >4 h. With additional capacity, the odds ratios for these predictors increased for age >65 years and ED LOS >4 h, and decreased for ATS category and ED diagnoses.Conclusions. Expanding ED capacity from 81 to 122 beds within a health service area impacted favourably on mortality outcomes, but not on time-related service outcomes such as ambulance offload time, time to see doctor and ED LOS. To improve all service outcomes, when altering (increasing or decreasing) ED bed numbers, the whole healthcare system needs to be considered. MODELS OF CAREWhat is known about the topic? Escalating growth in demand for emergency patient services has placed increasing strain on both ambulance and hospital resources. Poor patient outcomes can result from crowded EDs and hospitals. What does this paper add? This paper identifies that following the opening of a 41-bed ED within a health service area, there was an improvement in in-hospital mortality outcomes for those who arrived to the ED via ambulance. Data linkage enhanced our ability to report on and understand the impact on outcomes across several systems (ambulance, ED and hospital admission). This paper provides a foundation for further research regarding emergency services expansion from a geographical area-wide perspective. Easily identifiable predictors of hospital admission for ambulance-arriving patients that may be useful for informing patient flow strategies are highlighted. What are the implications for practitioners? Practitioners need to be aware that patients arriving by ambulance to the ED are more likely to require admission if they are older, triaged to higher acuity, have circulatory or respiratory conditions and have an ED LOS of >4 h. Service planners need to consider the whole system when planning expansion.

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Increasing utilisation of emergency ambulances

Cited by 188 publications

References 29 publications

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

Actividad y seguridad de la enfermera de urgencias a domicilio para patologías leves

Expanding emergency department capacity: a multisite study

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