Scoping review on alternative care options for patients calling the ambulance

The modern-day population with more chronic, complex medical and social comorbidities is increasing ambulance utilisation and conveyance to emergency departments (ED). This contributes to ambulance ramping, ED overcrowding and increased hospital bed utilisation. This scoping review aims to identify alternative care paths for patients calling for ambulance services.

A total of 4902 articles were identified through four databases and the gray literature. The terms 'paramedic', 'ambulance' and 'non-conveyance', 'alternative' and 'community care' were combined to yield the search terms. The population studied includes individuals calling the national emergency number while the intervention focuses on prehospital services designed to avoid ED conveyance. Independent researchers screened the titles, abstracts and full texts, yielding 59 relevant articles which were then meta-synthesised.

Five themes of care were identified - hear and treat, hear and refer, see and treat, see and refer and see and convey to a non-ED facility. Low-acuity patients, older patients, palliative and psychiatric patients, as well as those facing exacerbation of chronic conditions, alcoholic and frequent attenders appear to benefit from these alternative care service pathways (ACSPs). Allied health professionals such as nurses, social workers, occupational therapists, and physiotherapists collaborate with paramedics to frontload the care of these patients in the prehospital setting. Alternative conveyance destinations include general practices, geriatric wards, toxicology units, sobering centres and community hospitals.

Implementing ACSPs and integrating healthcare approaches to enhance service efficiency and patient outcomes can alleviate pressure on emergency services by providing timely care and directing patients to appropriate services.