Non-conveyance of older adult patients and association with subsequent clinical and adverse events after initial assessment by ambulance clinicians: A cohort analysis

Abstract

Background: Older adults (age ≥65 years) represent a significant proportion of all patients who are not transported to hospital after assessment by ambulance clinicians (non-conveyed patients). This study aimed to fill the knowledge gap in the understanding of the prevalence of older adult non-conveyed patients and investigate their characteristics and risk factors for subsequent and adverse events with those of younger non-conveyed patients comparatively.Methods: This population-based retrospective cohort study included all adult non-conveyed patients who availed the ambulance service of Region Stockholm, Sweden in 2015; they were age-stratified into two groups: 18–64 and ≥65 years. Inter-group differences in short-term outcomes (i.e. emergency department visits, hospitalisations, and mortality within 7 days following non-conveyance) were assessed using multivariate regression analyses.Results: Older adult patients comprised 48% of the 17,809 non-conveyed patients. Dispatch priority levels were generally lower among older non-conveyed patients than among younger patients. Non-conveyance among older patients occurred more often during daytime, and they were more frequently assessed by ambulance clinicians with nonspecific presenting symptoms. Approximately one in five older adults was hospitalised within 7 days following non-conveyance. Patients presenting with infectious symptoms had the highest mortality risk following non-conveyance. Oxygen saturation level <95% or systolic blood pressure >160 mmHg had significantly higher associations with hospitalisation within 7 days following non-conveyance in older adult patients.Conclusions: Older adult patients have an increased risk for adverse events following non-conveyance. In combination with a complex symptom presentation which proves difficult for dispatch operators and ambulance clinicians to identify, this risk raises questions on the patient safety of older adult non-conveyed patients.

Caring for older patients with reduced decision-making capacity. A deductive exploratory study of ambulance clinicians’ ethical competence

“…Older patients' vulnerability makes them potentially difficult to assess in acute care, as their needs are complex, thus not only medical, but also psychological, social and existential, in combination with a lowered personal capacity to act appropriately on their own behalf (10). This group of older patients constitutes a significant proportion of non-convey patients, as they are often classified as having non-specific complaints that do not fit with the ambulance clinicians' (ACs) assessment protocols (11). ACs, who consider themselves as providers of emergency medical care working under high workloads of dispatch calls, have described themselves as being in a struggle between differing expectations when they disagree with the older patients' request for emergency care, while also enjoying taking an interest in their problems and in providing them comfort (12).…”

Prehospital nursing students' experiences of patient safety culture in emergency medical services—A qualitative study

“…For example, a previous study asserts that key issues of patient safety are technical skill, competence and factors related to EMS working environments (Atack & Maher, 2009). Patient safety issues in EMS are mainly focused on clinical judgement, adverse events and error reporting, communications, ground vehicle safety, aircraft safety, interfacility transport, field intubation (Bigham et al, 2012) and non‐conveyed patients (Lederman et al, 2021; Paulin et al, 2021). Teamwork has also been recognised as a visible manifestation of a patient safety culture (Reiman et al, 2010; Sammer et al, 2010).…”