Path Analysis Modeling Indicates Free Transport Increases Ambulance Use for Minor Indications

Ting, Joseph; Chang, Allan

doi:10.1080/10903120600885209

Cited by 19 publications

(21 citation statements)

References 17 publications

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“…10 Some years later the introduction of a small universal levy, following abolition of any direct patient fees, realised an increase in usage. 12 Of particular interest, was an increase in use by a younger age group with lower clinical acuity. A survey recently conducted in Japan investigated the effect of introducing user charges on demand.…”

Section: Pricing and Accessibilitymentioning

confidence: 99%

Increasing utilisation of emergency ambulances

Lowthian¹,

Cameron²,

Stoelwinder³

et al. 2011

Aust. Health Review

188

161

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Background. Increased ambulance utilisation is closely linked with Emergency Department (ED) attendances. Pressures on hospital systems are widely acknowledged with ED overcrowding reported regularly in the media and peer-reviewed literature. Strains on ambulance services are less well-documented or studied.Aims. To review the literature to determine the trends in utilisation of emergency ambulances throughout the developed world and to discuss the major underlying drivers perceived as contributing to this increase.Method. A search of online databases, search engines, peer-reviewed journals and audit reports was undertaken. Findings. Ambulance utilisation has increased in many developed countries over the past 20 years. Annual growth rates throughout Australia and the United Kingdom are similar. Population ageing, changes in social support, accessibility and pricing, and increasing community health awareness have been proposed as associated factors. As the extent of their contribution has not yet been established these factors were reviewed.Conclusion. The continued rise in utilisation of emergency ambulances is placing increasing demands on ambulance services and the wider health system, potentially compromising access, quality, safety and outcomes. A variety of factors may contribute to this increase and targeted strategies to reduce utilisation will require an accurate identification of the major drivers of demand.What is known about the topic? Ambulance utilisation is increasing annually throughout the developed world, with previous research suggesting numerous underlying factors. What does this paper add? These factors have not been previously synthesised in the international literature. This narrative review clearly articulates the underlying problems. What are the implications for practitioners? This paper outlines the need for further research of the causes of increased emergency ambulance utilisation, to enable the development of appropriate strategies to manage demand in the future.

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Section: Pricing and Accessibilitymentioning

confidence: 99%

Increasing utilisation of emergency ambulances

Lowthian¹,

Cameron²,

Stoelwinder³

et al. 2011

Aust. Health Review

188

161

View full text Add to dashboard Cite

show abstract

“…Consequently, developing an effective control system for determining patients who really need transportation is of the utmost urgency. A basic prerequisite for developing such a system is to determine “who” really needs ambulance services, “why” he/she needs such services, and “where” he/she is located [10]. …”

Section: Introductionmentioning

confidence: 99%

Exploring Factors Affecting Emergency Medical Services Staffs’ Decision about Transporting Medical Patients to Medical Facilities

Ebrahimian

Seyedin

Jamshidi-Orak

et al. 2014

Emergency Medicine International

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Transfer of patients in medical emergency situations is one of the most important missions of emergency medical service (EMS) staffs. So this study was performed to explore affecting factors in EMS staffs' decision during transporting of patients in medical situations to medical facilities. The participants in this qualitative study consisted of 18 EMS staffs working in prehospital care facilities in Tehran, Iran. Data were gathered through semistructured interviews. The data were analyzed using a content analysis approach. The data analysis revealed the following theme: “degree of perceived risk in EMS staffs and their patients.” This theme consisted of two main categories: (1) patient's condition' and (2) the context of the EMS mission'. The patent's condition category emerged from “physical health statuses,” “socioeconomic statuses,” and “cultural background” subcategories. The context of the EMS mission also emerged from two subcategories of “characteristics of the mission” and EMS staffs characteristics'. EMS system managers can consider adequate technical, informational, financial, educational, and emotional supports to facilitate the decision making of their staffs. Also, development of an effective and user-friendly checklist and scoring system was recommended for quick and easy recognition of patients' needs for transportation in a prehospital situation.

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“…Improper use of prehospital EMS leads to wasting limited resources, idling real emergency patients to receive appropriate care, increasing morbidity and mortality rate of patients with conditions that require emergency services, low-quality performance, and job dissatisfaction in prehospital emergency staffs [5]. Therefore, establishing a control mechanism can reduce unnecessary patient transfer and inappropriate use of EMS [9]. …”

Section: Introductionmentioning

confidence: 99%

Physiological-Social Scores in Predicting Outcomes of Prehospital Internal Patients

Ebrahimian

Seyedin

Jamshidi-Orak

et al. 2014

Emergency Medicine International

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The physiological-social modified early warning score system is a newly developed instrument for the identification of patients at risk. The aim of this study was to investigate the feasibility of using the physiological-social modified early warning score system for the identification of patients that needed prehospital emergency care. This prospective cohort study was conducted with 2157 patients. This instrument was used as a measure to detect critical illness in patients hospitalised in internal wards. Judgment by an emergency medicine specialist was used as a measure of standard. Data were analyzed by using receiver operating characteristics curves and the area under the curve with 95% confidence interval. The mean score of the physiological-social modified early warning score system was 2.71 ± 3.55. Moreover, 97.6% patients with the score ≥ 4 needed prehospital emergency services. The area under receiver operating characteristic curve was 0.738 (95% CI = 0.708–0.767). Emergency medical staffs can use PMEWS ≥ 4 to identify those patients hospitalised in the internal ward as at risk patients. The physiological-social modified early warning score system is suggested to be used for decision-making of emergency staff about internal patients' wards in EMS situations.

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Path Analysis Modeling Indicates Free Transport Increases Ambulance Use for Minor Indications

Cited by 19 publications

References 17 publications

Increasing utilisation of emergency ambulances

Increasing utilisation of emergency ambulances

Exploring Factors Affecting Emergency Medical Services Staffs’ Decision about Transporting Medical Patients to Medical Facilities

Physiological-Social Scores in Predicting Outcomes of Prehospital Internal Patients

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