Follow-up of elderly patients who refuse transport after accessing 9-1-1

To obtain medical follow-up and determine reasons why elderly patients access paramedics via 9-1-1 and then refuse transport.

A telephone survey of patients aged 65 years and older who refused transport and signed out against medical advice (AMA) after accessing paramedics via 9-1-1 was performed to obtain information about the patients' experiences, reasons why they refused, medical follow-up, and patient outcomes.

One hundred of 121 (83%) patients who were contacted by telephone participated in the survey. Patients stated that financial concerns were a major determinant in refusing to be transported. Overall, 70% of the patients reported receiving follow-up medical care. Care was obtained at an emergency department (ED) via a second 9-1-1 call in 16% of cases, at an ED via private vehicle in 13%, at an urgent care clinic by a private vehicle in 35%, and with a family physician via private car in 38% of cases. Of the patients who obtained follow-up, there was a 32% hospital admission rate, with 39% of those admitted to an intensive care unit setting. Finally, 80% of the sample studied did not speak to a physician online, with 49% stating that they would have changed their minds if a physician had suggested transport.

The majority of patients who were 65 years of age and older and refused transport received follow-up care, with a significant number requiring admission to the hospital at the time of their follow-up.