Gatekeepers: a missed opportunity for safe transport

Area of Science:

• Emergency Medicine
• Cardiology
• Health Services Research

Background:

• Patients presenting with acute chest pain to the emergency department (ED) may utilize ambulance services for transport.
• The role of pre-hospital healthcare provider contact in influencing ambulance use for chest pain presentations is not fully understood.

Purpose of the Study:

• To determine if contact with a healthcare provider or gatekeeper influences ambulance utilization among patients with acute chest pain.

Main Methods:

• A convenience sample of adults aged 40 or older presenting with chest pain to an urban university hospital ED were interviewed.
• Data collected included mode of transport, prior contact with a healthcare provider, and any transport instructions received.
• Patients with hemodynamic instability or those undergoing acute interventions were excluded.

Main Results:

• 42% of 450 patients arrived by ambulance.
• Patients with prior healthcare provider contact were less likely to arrive by ambulance (31%) compared to those without contact (51%, p < 0.001).
• This trend persisted across subgroups, including those with cardiac enzyme testing and confirmed acute myocardial infarction, with significantly lower ambulance use in patients who had provider contact.

Conclusions:

• Pre-ED healthcare provider contact is associated with a reduced likelihood of ambulance transport for patients presenting with chest pain.
• Patients who recalled transport instructions from providers were more likely to follow them, influencing their mode of arrival.