An analysis of characteristics and associated factors for re-contacts after EMS non-conveyance: a retrospective cohort study in the Netherlands.

Abstract

Background: Non-conveyed patients are a significant population within ambulance care. To gain insight in patient safety for this population, ambulance re-contacts within 72 h are monitored. However, little is known about the background of these non-conveyance cases with a re-contact. This study aims to investigate the incidence of re-contacts, analyse characteristics, and identify factors associated with re-contacts following non-conveyance.

Methods: This was a retrospective cohort study of all non-conveyance cases and all associated re-contacts in two EMS regions in the Netherlands, Gelderland-Zuid and Gelderland-Midden. Data was collected from 1 January 2022 till 31 December 2022. Characteristics of non-conveyance cases with and without a re-contact within 72 h were compared and differences were analysed univariately. Logistic regression analyses were used to quantify bivariate and multivariable associations between characteristics of non-conveyance cases and EMS re-contact within 72 h. Associations are expressed in odds ratios with 95% confidence interval.

Results: In the analysis of 19.563 cases, the overall incidence for an EMS re-contact within 72 h was 5.0% (N = 984/19.563), with 3.4% (669/19.563) within 24 h, 1.0% (195/19.563) within 24-48 h and 0.6% (120/19.563) within 48-72 h. In a subset of 13.010 complete cases, significant multivariable associations were observed between re-contacts and age > 65 (OR 2.15, CI 1.82-2.53), male gender (OR 1.39, CI 1.18-1.63), and medical complaints related to specialism 'Pulmonology' (OR 2.45, CI 1.67-3.64), 'Neurology' (OR 1.81, CI 1.28-2.59) and 'Traumatology/surgery' (OR 0.51, CI 0.34-0.76). Other significant associations were noted with night-time cases (OR 1.49, CI 1.21-1.82) and cases in which consultation or handover to a general practitioner occurred (OR 1.25, CI 1.06-1.47).

Conclusions: A low overall incidence of EMS re-contacts indicates that non-conveyance within the EMS system is relatively safe. The likelihood of re-contact is higher for age above 65, male gender, and medical complaints within the specialisms of 'Pulmonology' and 'Neurology'. Non-conveyance cases that involve consultation or handover to a GP and cases occurring at night are also more likely to have a re-contact. The findings inform non-conveyance decision-making, and could serve as a starting point to adapt EMS curricula, and develop guidelines and protocols. This may fuel the enhancement of non-conveyance decision-making, thereby improving the quality of healthcare within the EMS system.