Which Emergency Medical Dispatch Codes Predict High Prehospital Nontransport Rates in an Urban Community?

Hodell, Evan; Sporer, Karl A.

doi:10.3109/10903127.2013.825349

Cited by 20 publications

(11 citation statements)

References 28 publications

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“…Low-acuity dispatch codes included abdominal pain, assault, back pain, pregnancy and childbirth, injuries and psychiatric conditions20 and were validated in the same area,21 but did not turn out to be low-acuity in another community 22. Non-transport after EMS dispatch was especially more common after assault/sexual assault, unknown problem/man down, traffic/transportation accidents, unconscious/fainting23 and mental, behavioural and neurodevelopmental disorders 24. Our analysis shows that, compared with dispatch for cardiovascular problems, odds of discharge were especially high for cases transported after accidents or trauma, emergencies involving children and emergencies where dispatchers did not specify the reason for dispatch.…”

Section: Discussionmentioning

confidence: 99%

Differences between cases admitted to hospital and discharged from the emergency department after emergency medical services transport

2019

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ObjectiveRising emergency medical services (EMS) utilisation increases transport to hospital emergency departments (ED). However, some patients receive outpatient treatment (discharged) while others are hospitalised (admitted). The aims of this analysis were to compare admitted and discharged cases, to assess whether cases that were discharged from the ED could be identified using dispatch data and to compare dispatch keyword categories and hospital diagnoses.DesignRetrospective observational study using linked secondary data.Setting and participants78 303 cases brought to 1 of 14 ED in the city of Munich, Germany, by EMS between 1 July 2013 and 30 June 2014.Main outcome measuresCharacteristics of admitted and discharged cases were assessed. Logistic regression was used to estimate the association between discharge and age, sex, time of day, ambulance type and dispatch keyword category. Keyword categories were compared to hospital diagnoses.Results39.4% of cases were discharged. They were especially likely to be young (OR 10.53 (CI 9.31 to 11.92), comparing <15-year-olds to >70-year-olds) and to fall under the categories ‘accidents/trauma’ (OR 2.87 (CI 2.74 to 3.01)) or ‘other emergencies (unspecified)’ (OR 1.23 (CI 1.12 to 1.34) (compared with ‘cardiovascular’). Most frequent diagnoses came from chapter ‘injury and poisoning’ (30.1%) of the 10th revision of the international statistical classification of disease and related health problems (ICD-10), yet these diagnoses were more frequent at discharge (42.7 vs 22.0%) whereas circulatory system disease was less frequent (2.6 vs 21.8%). Except for accidents/trauma and intoxication/poisoning many underlying diagnoses were observed for the same dispatch keyword.ConclusionYoung age and dispatch for accidents or trauma were the strongest predictors of discharge. Even within the same dispatch keyword category the distribution of diagnoses differed between admitted and discharged cases. Discharge from the ED does not indicate that urgent response was unnecessary. However, these cases could be suitable for allocation to hospitals with low inpatient bed capacities and are of particular interest for future studies regarding the urgency of their condition.

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Section: Discussionmentioning

confidence: 99%

Differences between cases admitted to hospital and discharged from the emergency department after emergency medical services transport

2019

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“…Yet, it could be that in Germany "inpatient stay" itself is not the best indicator for objective need, as Germany's hospital admission rate is third highest in Europe and also the rate ofavoidable admissions is considered to be high [25]. Similarly, a "transport" itself and especially "transports to hospitals" seem to be inadequate objective indicators: Germany's rate of EMS transports per case is higher than in other European countries [26,27] and the U.S. [28]. Analysis of Bavarian dispatch data hint that about 20% of the patients are not transported to a hospital [29].…”

Section: Discussionmentioning

confidence: 99%

Which health-related reasons lead to prehospital emergency care and how does subjective emergency status connect to subsequent care?

Piedmont

Reinhold

Bock³

et al. 2021

Notfall Rettungsmed

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Objectives/Background In many countries, the use of emergency medical services (EMS) increases steadily each year. At the same time, the percentage of life-threatening complaints decreases. To redesign the system, an assessment and consideration of the patients’ perspectives is helpful. Methods We conducted a paper-based survey of German EMS patients who had at least one case of prehospital emergency care in 2016. Four health insurance companies sent out the questionnaire to 1312 insured persons. We linked the self-reported data of 254 respondents to corresponding claims data provided by their health insurance companies. The analysis focuses a.) how strongly patients tend to call EMS for themselves and others given different health-related scenarios, b.) self-perceived health complaints in their own index case of prehospital emergency care and c.) subjective emergency status in combination with so-called “objective” characteristics of subsequent EMS and inpatient care. We report principal diagnoses of (1) respondents, (2) 57,240 EMS users who are not part of the survey and (3) all 20,063,689 inpatients in German hospitals. Diagnoses for group 1 and 2 only cover the inpatient stay that started on the day of the last EMS use in 2016. Results According to the survey, the threshold to call an ambulance is lower for someone else than for oneself. In 89% of all cases during their own EMS use, a third party called the ambulance. The most common, self-reported complaints were pain (38%), problems with heart and circulation (32%), and loss of consciousness (17%). The majority of respondents indicated that their EMS use was due to an emergency (89%). We could detect no or only weak associations between patients’ subjective urgency and different items for objective care. Conclusion Dispatchers can possibly optimize or reduce the disposition of EMS staff and vehicles if they spoke directly to the patients more often. Nonetheless, there is need for further research on how strongly the patients’ perceived urgency may affect the disposition, rapidness of the service and transport targets.

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“…[15][16][17] One study using the AMPDS triage system showed a substantially higher rate of non-transport (25%), though codes with high non-transport rates were not seen in our study (ie, traffic accidents, sexual assault). 18 The reason for these high rates of transport is in part due to the fact that the 911 EMS system is regulated by the Department of Transportation and personnel working in this system have no option other than to transport patients to the ED. In fact, there is no reimbursement for an EMS response that does not result in ED transport, even if the patient and family refuse.…”

Section: Discussionmentioning

confidence: 99%

Community paramedics treat high acuity conditions in the home: a prospective observational study

Abrashkin

Poku

Ramjit

et al. 2019

BMJ Support Palliat Care

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Objectives As the US population ages and healthcare reimbursement shifts, identifying new patient-centred, cost-effective models to address acute medical needs will become increasingly important. This study examined whether community paramedics can evaluate and treat, under the direction of a credentialed physician, high acuity medical conditions in the home within an advanced illness management (AIM) practice. Methods A prospective observational study of an urban/suburban community paramedicine (CP) programme, with responses initiated based on AIM-practice protocols and triaged prior to dispatch using the Advanced Medical Priority Dispatch System (AMPDS). Primary outcome was association between AMPDS acuity levels and emergency department (ED) transport rates. Secondary outcomes were ED presentations at 24 and 48 hours post-visit, and patient/caregiver survey results. results 1159 individuals received 2378 CP responses over 4 years. Average age was 86 years; dementia, heart failure and asthma/ chronic obstructive pulmonary disease were prevalent. Using AMPDS, most common reasons for dispatch included 'breathing problems' (28.2%), 'sick person' (26.5%) and 'falls' (13.1%). High acuity responses were most prevalent. 17.9% of all responses and 21.0% of high acuity responses resulted in ED transport. Within 48 hours of the visit, only 5.7% of the high acuity responses not initially transported were transported to the ED. Patient/caregiver satisfaction rates were high. conclusion Community paramedics, operating within an AIM programme, can evaluate and treat a range of conditions, including high acuity conditions, in the home that would typically result in ED transport in a conventional 911 system. This model may provide an effective means for avoiding hospital-based care, allowing older adults to age in place.on July 4, 2020 by guest. Protected by copyright.

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Which Emergency Medical Dispatch Codes Predict High Prehospital Nontransport Rates in an Urban Community?

Cited by 20 publications

References 28 publications

Differences between cases admitted to hospital and discharged from the emergency department after emergency medical services transport

Differences between cases admitted to hospital and discharged from the emergency department after emergency medical services transport

Which health-related reasons lead to prehospital emergency care and how does subjective emergency status connect to subsequent care?

Community paramedics treat high acuity conditions in the home: a prospective observational study

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