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. 2018 Sep 21;13(9):e0204508.
doi: 10.1371/journal.pone.0204508. eCollection 2018.

Why do ambulance services have different non-transport rates? A national cross sectional study

Alicia O'Cathain  1 , Richard Jacques  1 , Tony Stone  1 , Janette Turner  1
Affiliations

Why do ambulance services have different non-transport rates? A national cross sectional study

Alicia O'Cathain et al. PLoS One. .

Abstract

Background: Some patients calling ambulance services (known as Emergency Medical Services internationally) are not transported to hospital. In England, national ambulance quality indicators show considerable variation in non-transport rates between the ten large regional ambulance services. The aim of this study was to explain variation between ambulance services in two types of non-transport: discharge at scene and telephone advice.

Methods: Mixed model logistic regressions using one month of data (November 2014) from the Computer Aided Despatch systems of the ten large regional ambulance services in England.

Results: 41% (251 677/615 815) of patients calling ambulance services were not transported to hospital. Most were discharged at scene after attendance by an ambulance (29% n = 182 479) and a small percentage were given telephone advice (7% n = 40 679). Discharge at scene rates varied by patient-level factors e.g. they were higher for elderly patients, where the reason for calling was falls, and for patients attended by paramedics with extended skills. These patient-level factors did not explain variation between ambulance services. After adjustment for patient-level factors, the following ambulance service level factors explained variation in discharge at scene rates: proportion of patients attended by paramedics with extended skills (odds ratio 1.05 (95% CI 1.04, 1.07)), the perception of ambulance service staff that paramedics with extended skills were established and valued within the workforce (odds ratio 1.84 (1.45, 2.33), and the perception of ambulance service staff that senior management viewed non-transport as risky (odds ratio 0.78 (0.63, 0.98)). Variation in telephone advice rates could not be explained.

Conclusions: Variation in discharge at scene rates was explained by differences in workforce configuration and managerial motivation, factors that are largely modifiable by ambulance services.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Variation in discharge at scene rates between ambulances services (based on 9 ambulance services with skill-mix data).
Fig 2
Fig 2. Variation in telephone advice rates between ambulances services (based on 10 ambulance services).
See this image and copyright information in PMC

References

    1. Alrazeeni DM, Sheikh SA, Mobrad A, Ghamdi MA, Abdulqader N, Gadgab MA, et al. Epidemiology of non-transported emergency medical services calls in Saudi Arabia. Saudi Med J 2016;37(5):575–8. doi: 10.15537/smj.2016.5.13872 - DOI - PMC - PubMed
    1. Ebben RH, Vloet LC, Speijers RF, Tonjes NW, Loef J, Pelgrim T, et al. A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review. Scandinavian Journal of Trauma, Resuscitation and Emergency. 2017;25(1). - PMC - PubMed
    1. Mikolaizak AS, Simpson PM, Tiedemann A, Lord SR, Close JC. Systematic review of non‐transportation rates and outcomes for older people who have fallen after ambulance service call‐out. Australasian journal on ageing. 2013;32(3):147–57. 10.1111/ajag.12023 - DOI - PubMed
    1. Eastwood K, Morgans A, Smith K, Hodgkinson A, Becker G, Stoelwinder J. A novel approach for managing the growing demand for ambulance services by low-acuity patients. Australian Health Review. 2016;40(4):378–84. 10.1071/AH15134 - DOI - PubMed
    1. Bray BD, Steventon A. What have we learnt after 15 years of research into the ‘weekend effect’? BMJ Qual Saf 2017;26:607–10. 10.1136/bmjqs-2016-005793 - DOI - PubMed

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