Exploring care pathways of patients conveyed by emergency medical services (EMS) through electronic health records.

Abstract

Background: Emergency Medical Services (EMS) and Emergency Departments (ED) have reported increased patient volumes in the last decades. Despite high rates of non-conveyance decisions, unnecessary conveyances by EMS still occur. The aim of this study was to explore care pathways of conveyed patients by EMS through registry data.

Methods: This was a retrospective cohort study of EMS patients in Finland. The primary outcomes were EMS recontacts and visits to a primary health care facility or ED within seven days. The secondary outcome was mortality within one week. Univariate and multivariable associations between the outcome variables and categorical variables were analysed with logistic regression. Results are presented with odds ratios (ORs) together with 95% confidence intervals (CIs) and p-values.

Results: The conveyed patients' visits to health care facilities were mainly brief. EMS arrival during night-time (20:00-08:00) (OR 1.69; 95% CI 1.59 to 1.80), in urban area (OR 1.21; 95% CI 1.13 to 1.29) and alcohol use (OR 2.55; 95% CI 2.26 to 2.86) predicted short ED visits (< 24 h). 77% of the patients were discharged from primary health care within one hour (median 22 min, IQR 18-60). After EMS conveyance and visit to the ED or primary health care facility, 10.5% of the patients were readmitted within one week. Non-urgent patients (OR 1.26; 95% CI 1.14 to 1.39), an EMS mission at night (OR 1.36; 95% CI 1.24 to 1.50), and based on univariate analyses, the usage of alcohol (OR 1.26; 95% CI 1.09 to 1.45) increased the likelihood of a readmission. 449 patients of all conveyed EMS patients (n = 20376) died within one week (2.2%).

Conclusions: EMS non-conveyance reduces patient flow in EDs, but there is a possibility that more could be done related to unnecessary conveyances to health care facilities, especially in urban areas and at night. The pathway analyses of post conveyance re-contacts show that a small number of patients burden the system. Further in-depth studies are needed to understand of unnecessary conveyances, find solutions, and provide repeated users the appropriate care.