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EMS non-conveyance: A safe practice to decrease ED crowding or a threat to patient safety?

Jani Paulin1, Jouni Kurola2, Mari Koivisto3

  • 1Department of Clinical Medicine, University of Turku and Turku University of Applied Sciences, Turku, Finland. jani.paulin@utu.fi.

BMC Emergency Medicine
|October 10, 2021
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Summary
This summary is machine-generated.

Emergency Medical Service (EMS) non-conveyance decisions are safe for most patients, with only a small percentage requiring re-contact or hospital visits. This practice helps manage emergency department resources effectively.

Keywords:
Adverse outcomeEmergency medical serviceNon-conveyancePatient safety

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Area of Science:

  • Emergency Medicine
  • Public Health
  • Health Services Research

Background:

  • Evaluating the safety of Emergency Medical Service (EMS) non-conveyance decisions is crucial for optimizing healthcare resource allocation.
  • Adverse outcomes, including re-contacts, primary healthcare visits, emergency department (ED) visits, and hospitalizations within 48 hours, were assessed.

Purpose of the Study:

  • To assess the safety and outcomes of EMS non-conveyance decisions.
  • To identify factors associated with adverse events following non-conveyance.

Main Methods:

  • A prospective cohort study of 11,861 non-conveyed EMS patients across three Finnish regions (June-November 2018).
  • Comparison of International Classification of Primary Care (ICPC2) with hospital discharge diagnoses (ICD10).
  • Multivariable logistic regression analysis to determine factors associated with adverse outcomes, including 28-day mortality.

Main Results:

  • Only 6.3% of non-conveyed patients had EMS re-contacts, 8.3% visited primary care, 4.2% visited the ED, and 1.6% were hospitalized within 48 hours.
  • Factors associated with increased primary healthcare visits included non-urgent EMS missions, night arrivals, advanced life support (ALS) units, rural areas, and older patient age.
  • A low rate of 0.1% mortality and 0.3% intensive care unit admissions were observed within 24 hours post-non-conveyance.

Conclusions:

  • The majority of patients (80%) did not require follow-up care after EMS non-conveyance.
  • EMS non-conveyance appears to be a safe strategy for managing emergency department resources and reducing crowding.