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Exploring variation in how ambulance services address non-conveyance: a qualitative interview study.BMJ Open Nov 2018There is considerable variation in non-conveyance rates between ambulance services in England. The aim was to explore variation in how each ambulance service addressed...
OBJECTIVES
There is considerable variation in non-conveyance rates between ambulance services in England. The aim was to explore variation in how each ambulance service addressed non-conveyance for calls ending in telephone advice and discharge at scene.
DESIGN
A qualitative interview study.
SETTING
Ten large regional ambulance services covering 99% of the population in England.
PARTICIPANTS
Between four and seven interviewees from each ambulance service including managers, paramedics and healthcare commissioners, totalling 49 interviews.
METHODS
Telephone semistructured interviews.
RESULTS
The way interviewees in each ambulance service discussed non-conveyance within their organisation varied for three broad themes. First, ambulance service senior management appeared to set the culture around non-conveyance within an organisation, viewing it either as an opportunity or as a risky endeavour. Although motivation levels to undertake non-conveyance did not appear to be directly affected by the stability of an ambulance service in terms of continuity of leadership and externally assessed quality, this stability could affect the ability of the organisation to innovate to increase non-conveyance rates. Second, descriptions of workforce configuration differed between ambulance services, as well as how this workforce was used, trained and valued. Third, interviewees in each ambulance service described health and social care in the wider emergency and urgent care system differently in terms of availability of services that could facilitate non-conveyance, the amount of collaborative working between health and social care services and the ambulance service and complexity related to the numbers of services and healthcare commissioners with whom they had to work.
CONCLUSIONS
This study suggests that factors within and outside the control of ambulance services may contribute to variation in non-conveyance rates. These findings can be tested in a quantitative analysis of factors affecting variation in non-conveyance rates between ambulance services in England.
Topics: Ambulances; Emergency Medical Services; England; Health Services Accessibility; Health Workforce; Humans; Interdisciplinary Communication; Intersectoral Collaboration; Interviews as Topic; Patient Discharge; Patient Handoff; Qualitative Research; Referral and Consultation; State Medicine; Unnecessary Procedures
PubMed: 30498049
DOI: 10.1136/bmjopen-2018-024228 -
Scandinavian Journal of Trauma,... Oct 2022In a two-tier Emergency Medical Services response system with ambulances and physician-staffed rapid response vehicles, both units are ideally dispatched simultaneously...
BACKGROUND
In a two-tier Emergency Medical Services response system with ambulances and physician-staffed rapid response vehicles, both units are ideally dispatched simultaneously when a physician is needed. However, when advanced resources are dispatched secondarily, a meeting point (rendezvous) is established to reduce time to advanced care. This study aims to assess the extent of rendezvous tasks, patient groups involved and physician contribution when rendezvous is activated between the primary ambulances and rapid response vehicles in the Capital Region of Denmark.
METHODS
We analysed prehospital electronic patient record data from all rendezvous cases in the Capital Region of Denmark in 2018. Variables included the number of times rendezvous was activated, patient demographics, dispatch criteria, on-scene diagnosis, and prehospital treatment.
RESULT
Ambulances requested rendezvous 2340 times, corresponding to 1.3% of all ambulance tasks and 10.7% of all rapid response vehicle dispatches. The most frequently used dispatch criterion was unclear problem n = 561 (28.8%), followed by cardiovascular n = 439 (22.5%) and neurological n = 392 (20.1%). The physician contributed with technical skills like medication n = 760 (39.0%) and advanced airway management n = 161 (8.3%), as well as non-technical skills like team leading during advanced life support n = 152 (7.8%) and decision to end futile treatment and death certificate issuance n = 73 (3.7%).
CONCLUSION
Rendezvous between ambulances and physician-staffed rapid response vehicles was activated in 1.3% of all ambulance cases corresponding to 10.7% of all RRV dispatches in 2018. The three largest patient groups in rendezvous presented cardiovascular, neurological, and respiratory problems. The prehospital physician contributed with technical skills like medication and advanced airway management as well as non-technical skills like team leading during advanced life support and ending futile treatment. The high percentage of dispatch criterion unclear problem illustrates the challenge of precise dispatch and optimal use of prehospital resources. Therefore, it seems necessary to have a safe and rapid rendezvous procedure to cope with this uncertainty.
Topics: Airway Management; Ambulances; Denmark; Emergency Medical Services; Humans; Physicians
PubMed: 36221109
DOI: 10.1186/s13049-022-01040-2 -
BMJ Open Feb 2023Ambulance diversion and prolonged prehospital transfer time have a significant impact on patient care outcomes. Self-harm behaviour in particular is associated with... (Observational Study)
Observational Study
Are hospitals with both medical/surgical and psychiatric services associated with decreased difficulty in ambulance transfer for patients with self-harm behaviour? A nationwide retrospective observational study using ambulance transfer data in Japan.
OBJECTIVES
Ambulance diversion and prolonged prehospital transfer time have a significant impact on patient care outcomes. Self-harm behaviour in particular is associated with difficulty in hospital acceptance and longer prehospital transfer time. This study aimed to determine if hospitals with both medical/surgical and psychiatric inpatient beds and high-level emergency care centres are associated with a decreased rate of difficulty in hospital acceptance and shorter prehospital transfer time for patients seeking medical care after self-harm behaviour.
DESIGN AND SETTING
A retrospective observational study using the database of Japanese ambulance dispatch data in 2015.
PARTICIPANTS
Patients who were transferred by ambulances after self-harm behaviour.
INTERVENTIONS
None.
MAIN OUTCOME MEASURES
Multivariable logistic regression analysis and multivariable linear regression analysis were performed to assess whether the presence of hospitals with both medical/surgical and psychiatric inpatient beds and high-level emergency care centres in the city were associated with a decreased rate of difficulty in hospital acceptance and shorter prehospital transfer time.
RESULTS
The number of transfers due to self-harm behaviour in 2015 was 32 849. There was an association between decreased difficulty in hospital acceptance and the presence of high-level emergency care centres (OR 0.63, 95% CI 0.55 to 0.71, p<0.01) and hospitals with both medical/surgical and psychiatric inpatient beds (OR 0.50, 95% CI 0.38 to 0.66, p<0.01). There was a significant reduction in prehospital transfer time in the city with high-level emergency care centres (4.21 min, 95% CI 3.53 to 4.89, p<0.01) and hospitals with medical/surgical and psychiatric inpatient beds (3.46 min, 95% CI 2.15 to 4.77, p<0.01).
CONCLUSION
Hospitals with both medical/surgical and psychiatric inpatient beds and high-level emergency care centres were associated with significant decrease in difficulty in hospital acceptance and shorter prehospital transfer time.
Topics: Humans; Ambulances; Japan; Emergency Medical Services; Hospitals; Self-Injurious Behavior; Mental Health Services
PubMed: 36828651
DOI: 10.1136/bmjopen-2022-065466 -
BMC Emergency Medicine Dec 2021The transport of patients from one location to another is a fundamental part of emergency medical services. However, little interest has been shown in the actual driving...
BACKGROUND
The transport of patients from one location to another is a fundamental part of emergency medical services. However, little interest has been shown in the actual driving of the ambulance. Therefore, this review aimed to investigate how the driving of the ambulance affects the patient and the medical care provided in an emergency medical situation.
METHODS
A systematic integrative review using both quantitative and qualitative designs based on 17 scientific papers published between 2011 and 2020 was conducted.
RESULTS
Ambulance driving, both the actual speed, driving pattern, navigation, and communication between the driver and the patient, influenced both the patient's medical condition and the possibility of providing adequate care during the transport. The driving itself had an impact on prehospital time spent on the road, safety, comfort, and medical issues. The driver's health and ability to manage stress caused by traffic, time pressure, sirens, and disturbing moments also significantly influenced ambulance transport safety.
CONCLUSIONS
The driving of the ambulance had a potential effect on patient health, wellbeing, and safety. Therefore, driving should be considered an essential part of the medical care offered within emergency medical services, requiring specific skills and competence in both medicine, stress management, and risk approaches in addition to the technical skills of driving a vehicle. Further studies on the driving, environmental, and safety aspects of being transported in an ambulance are needed from a patient's perspective.
Topics: Ambulances; Communication; Emergency Medical Services; Humans
PubMed: 34922453
DOI: 10.1186/s12873-021-00554-9 -
BMC Emergency Medicine Mar 2023Non-conveyed patients (i.e. patients who are not transported to a hospital after being assessed by ambulance clinicians) represent a significantly increasing proportion...
BACKGROUND
Non-conveyed patients (i.e. patients who are not transported to a hospital after being assessed by ambulance clinicians) represent a significantly increasing proportion of all patients seeking ambulance care. Scientific knowledge about patients' non-conveyance experiences is sparse. This study describes the lived experiences of non-conveyed patients in an ambulance care context.
METHODS
A reflective lifeworld research (RLR) approach founded on phenomenology is used. Data is derived from nine in-depth interviews with patients not conveyed by the ambulance service in a major Swedish region.
RESULTS
Patients' lived experiences of becoming acutely ill or injured and not conveyed by ambulance to a hospital are characterised by several dynamic movements: losing and regaining situational and bodily control, dependence and autonomy, external competence and inner knowledge, handing over and regaining responsibility, and fear and security.
CONCLUSIONS
Patients' lived experiences of non-conveyance are complex and versatile. Although non-conveyed patients initially experience strong fear and the loss of situational and bodily control, they gradually feel more secure when experiencing confirmation and trust, which evolves into insecurity and uncertainty. The non-conveyance situation's complexity from a patient's perspective implies the need for ambulance organisations to take measures to prevent further suffering. Non-conveyed patients must be taken seriously in their unique situations, requiring ambulance clinicians to reflect and act with a conscious ethical perspective before, during and after their visit.
Topics: Humans; Ambulances; Emergency Medical Services; Hospitals; Uncertainty; Qualitative Research
PubMed: 36927353
DOI: 10.1186/s12873-023-00797-8 -
BMC Emergency Medicine May 2024In pre-hospital setting, ambulance provides emergency care and means of transport to arrive at appropriate health centers are as vital as in-hospital care, especially,...
BACKGROUND
In pre-hospital setting, ambulance provides emergency care and means of transport to arrive at appropriate health centers are as vital as in-hospital care, especially, in developing countries. Accordingly, Ethiopia has made several efforts to improve accessibility of ambulances services in prehospital care system that improves the quality of basic emergency care. Yet, being a recent phenomenon in Ethiopia, empirical studies are inadequate with regard to the practice and determinants of ambulance service utilization in pre-hospital settings. Hence, this study aimed to assess the ambulance service utilization and its determinants among patients admitted to the Emergency Departments (EDs) within the context of pre-hospital care system in public hospitals of Jimma City.
METHOD
A cross-sectional study design was used to capture quantitative data in the study area from June to July 2022. A systematic sampling technique was used to select 451 participants. Interviewer-administered questionnaire was used to collect data. Data analysis was done using SPSS version 26.0; descriptive and logistic regressions were done, where statistical significance was determined at p < 0.05.
RESULTS
Ambulance service was rendered to bring about 39.5% (of total sample, 451) patients to hospitals. The distribution of service by severity of illnesses was 48.7% among high, and 39.4% among moderately acute cases. The major determinants of ambulance service utilization were: service time (with AOR, 0.35, 95%CI, 0.2-0.6 for those admitted to ED in the morning, and AOR, 2.36, 95%CI, 1.3-4.4 for those at night); referral source (with AOR, 0.2, 95%CI, 0.1-0.4 among the self-referrals); mental status (with AOR, 1.9, 95%CI, 1-3.5 where change in the level of consciousness is observed); first responder (AOR, 6.3 95%CI, 1.5-26 where first responders were the police, and AOR, 3.4, 95%C1, 1.7-6.6 in case of bystanders); distance to hospital (with AOR,0.37, 95%CI, 0.2-0.7 among the patients within ≤15km radius); and prior experience in ambulance use (with AOR, 4.1,95%CI, 2.4-7).
CONCLUSION
Although the utilization of ambulance in pre-hospital settings was, generally, good in Jimma City; lower levels of service use among patients in more acute health conditions is problematic. Community-based emergency care should be enhanced to improve the knowledge and use of ambulance services.
Topics: Humans; Ethiopia; Ambulances; Cross-Sectional Studies; Male; Female; Adult; Middle Aged; Emergency Medical Services; Adolescent; Surveys and Questionnaires; Young Adult; Emergency Service, Hospital; Aged
PubMed: 38735937
DOI: 10.1186/s12873-024-00999-8 -
BMC Emergency Medicine Jul 2017Medical care is obviously an important public service to ensure the health of a nation; however, medical resources are not always used appropriately. 'Convenience-store...
BACKGROUND
Medical care is obviously an important public service to ensure the health of a nation; however, medical resources are not always used appropriately. 'Convenience-store consultations' and inappropriate ambulance transportation represent instances of such improper use by contemporary Japanese citizens in recent years. This article illustrates two examples of misuse and discusses potential countermeasures by considering factors contributing to these behaviours.
MAIN BODY
From both public and medical perspectives, these patient behaviours are problematic, causing potential harm to others, negative consequences to such patients themselves, exhaustion of healthcare staff, and breakdown of emergency medical services. Although citizens need to recognize the public nature and scarcity of medical care, the more immediate need may be to identify and to remove personal and social causes inducing such misuse. In addition, healthcare professionals should become more trustworthy. To combat these issues, one-sided penalties such as accusations or sanctions for patients who misuse the system cannot be justified in principle. If measures taken to prevent misuse are ineffective, imposing surcharges or restricting consultations may be considered official policy, but these are not acceptable for several reasons.
CONCLUSION
For now, we conclude that we must rely on the spontaneous motivation of patients who engage in 'convenience-store consultations' and ambulance transportation instead of taking a taxi.
Topics: Ambulances; Emergency Medical Services; Emergency Service, Hospital; Health Services Misuse; Humans; Japan
PubMed: 28709409
DOI: 10.1186/s12873-017-0135-4 -
Telemedicine Journal and E-health : the... Jul 2019p
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Topics: Ambulances; Attitude of Health Personnel; Humans; Quality of Health Care; Severity of Illness Index; Simulation Training; Stroke; Telemedicine
PubMed: 30207927
DOI: 10.1089/tmj.2018.0044 -
Journal of Healthcare Engineering 2019A two-tiered ambulance system, consisting of advanced and basic life support for emergency and nonemergency patient care, respectively, can provide a cost-efficient...
A two-tiered ambulance system, consisting of advanced and basic life support for emergency and nonemergency patient care, respectively, can provide a cost-efficient emergency medical service. However, such a system requires accurate classification of patient severity to avoid complications. Thus, this study considers a two-tiered ambulance dispatch and redeployment problem in which the average patient severity classification errors are known. This study builds on previous research into the ambulance dispatch and redeployment problem by additionally considering multiple types of patients and ambulances, and patient classification errors. We formulate this dynamic decision-making problem as a semi-Markov decision process and propose a mini-batch monotone-approximate dynamic programming (ADP) algorithm to solve the problem within a reasonable computation time. Computational experiments using realistic system dynamics based on historical data from Seoul reveal that the proposed approach and algorithm reduce the risk level index (RLI) for all patients by an average of 11.2% compared to the greedy policy. In this numerical study, we identify the influence of certain system parameters such as the percentage of advanced-life support units among all ambulances and patient classification errors. A key finding is that an increase in undertriage rates has a greater negative effect on patient RLI than an increase in overtriage rates. The proposed algorithm delivers an efficient two-tiered ambulance management strategy. Furthermore, our findings could provide useful guidelines for practitioners, enabling them to classify patient severity in order to minimize undertriage rates.
Topics: Algorithms; Ambulances; Computer Simulation; Decision Making, Computer-Assisted; Decision Making, Organizational; Emergency Medical Services; Humans; Markov Chains; Republic of Korea; Severity of Illness Index; Triage
PubMed: 31885833
DOI: 10.1155/2019/6031789 -
BMC Health Services Research Jul 2021An estimated nine out of ten persons in sub-Saharan Africa (SSA) are unable to access timely, safe and affordable surgery. District hospitals (DHs) which are...
BACKGROUND
An estimated nine out of ten persons in sub-Saharan Africa (SSA) are unable to access timely, safe and affordable surgery. District hospitals (DHs) which are strategically located to provide basic (non-specialist) surgical care for rural populations have in many instances been compromised by resource inadequacies, resulting in unduly frequent patient referrals to specialist hospitals. This study aimed to quantify the financial burdens of surgical ambulance referrals on DHs and explore the coping strategies employed by these facilities in navigating the challenges.
METHODS
We employed a multi-methods descriptive case study approach, across a total of 14 purposively selected DHs; seven, three, and four in Tanzania, Malawi and Zambia, respectively. Three recurrent cost elements were identified: fuel, ambulance maintenance and staff allowances. Qualitative data related to coping mechanisms were obtained through in-depth interviews of hospital managers while quantitative data related to costs of surgical referrals were obtained from existing records (such as referral registers, ward registers, annual financial reports, and other administrative records) and expert estimates. Interview notes were analysed by manual thematic coding while referral statistics and finance data were processed and analysed using Microsoft Office Excel 2016.
RESULTS
At all but one of the hospitals, respondents reported inadequacies in numbers and functional states of the ambulances: four centres indicated employing non-ambulance vehicles to convey patients occassionally. No statistically significant correlation was found between referral trip distances and total annual numbers of referral trips, but hospital managers reported considering costs in referral practices. For instance, ten of the study hospitals reported combining patients to minimize trip frequencies. The total cost of ambulance use for patient transportation ranged from I$2 k to I$58 k per year. Between 34% and 79% of all patient referrals were surgical, with total costs ranging from I$1 k to I$32 k per year.
CONCLUSION
Cost considerations strongly influence referral decisions and practices, indicating a need for increases in budgetary allocations for referral services. High volumes of potentially avoidable surgical referrals provide an economic case - besides equitable access to healthcare - for scaling up surgery capacity at the district level as savings from decreased referrals could be reinvested in referral systems strengthening.
Topics: Adaptation, Psychological; Ambulances; Hospitals, District; Humans; Malawi; Referral and Consultation; Tanzania; Zambia
PubMed: 34301242
DOI: 10.1186/s12913-021-06709-5