Table 3 Follow-up care after non-conveyance

Anderson (2002) Denmark [32]

• Patient outcome – hospitalization

• Patient outcome – recurrent symptoms

• 76/968 (7.9%) patients have secondary blood glucose regulatory problems <72 h

 ◦ 46/76 (60.5%) have a recurrent hypoglycaemia, 33/46 (71.7%) of these cases occur <24-72 h

• 49/968 (5.1%) are hospitalized <72 h

 ◦ 21/49 (42.9%) have a recurrent hypoglycaemia of which 12/21 (57.1%) are hospitalized <24-72 h

Burstein (1996) USA [56]

• Repeat access general healthcare – GP

• Repeat access emergency healthcare – EMS (call or EMS run)

• Repeat access emergency healthcare – ED

• 199/321 (62.0%) patients who had follow-up.

 ◦ 95/199 (47.7%) patients sought additional medical care <1 week.

  ▪ 51/95 (53.7%) went to the ED: 7 through EMS, 41 referred themselves to the ED and 3 were referred by their physician.

  ▪ 44/95 (46.3%) were seen by their physician.

Burstein (1998) USA [57]

• Repeat access general healthcare – GP

• Repeat access emergency healthcare – ED

• Patient outcome – mortality

• Patient outcome – hospitalization

• 66/69 (95.7%) patients could be contacted through follow-up <2–3 days

 ◦ 33/66 (50.0%) patients saw their own physicians

 ◦ 17/66 (25.8%) went to an ED on their own

 ◦ 8/66 (12.1%) were admitted to the hospital

 ◦ 4/66 (6.1%) died

Cain (2003 USA [58]

• Repeat access emergency healthcare – EMS (call or EMS run)

40/145 (27.6%) patients had signs and symptoms compatible with low blood sugar occurring <10 months after initial event and requiring a repeat EMS call:

• 2/24 (8.3%) patients >65 years

• 38/121 (31.4%) patients <65 years

3/145 (2.1%) patients had signs and symptoms compatible with low blood sugar occurring <48 h after initial event and requiring a repeat EMS call:

• 0/24 (0.0%) patients >65 years

• 3/121 (2.5%) patients <65 years

• No significant differences in repeat (p = .43) any time during the ten-month study period, recurrences (p = .33) <48 h and interval for repeat episodes (p = .60) between conveyed and non-conveyed patient calls.

Carter (2002) Canada [59]

• Patient outcome – recurrent symptoms

Repeated access to healthcare <21 days:

• 6/41 (14.6%) patients for all complaints

• 2/41 (4.9%) patients for the same complaint

Cone (1995) USA [8]

• Repeat access general healthcare – GP

• Repeat access emergency healthcare – ED

• Patient outcome – hospitalization

54/81 (67%) had follow-up:

• 37/54 (68.5%) sought no medical care

• 10/54 (18.5%) were evaluated in the ED: 3 were discharged, 7 were admitted: 3 were admitted to monitored beds and 4 were admitted to unmonitored beds

• 7/54 (13.0%) saw their own physician <48 h after refusal

Haines (2006) USA [62]

• Repeat access general healthcare – GP

• Repeat access emergency healthcare – ED

• Patient outcome – hospitalization

527/704 (74.8%) completed phone follow-up:

• 13/527 (2.5%) non-transport group hospitalized

• 279/527 (52.9%) patients had follow-up-care <72 h (median 2.5 h, inter-quartile range 1.5–13 h)

 ◦ 203/279 (72.6%) patients had follow-up-care <12 h

 ◦ 148/279 (65.9%) patients came to ED

 ◦ 95/279 (34.1%) patients came via primary care physician

 ◦ 19/279 (6.8%) patients were evaluated by a medical provider more than once in 72 h

Højfeld (2014) Denmark [34]

• Repeat access emergency healthcare – ED

• Patient outcome – mortality

• Patient outcome – hospitalization

113/1609 (7.0%) patients had renewed treatment in hospital or ED <24 h

 ◦ 58/113 (51.3%) had to be admitted

 ◦ 51/113 (45.1%) visited the ED

 ◦ 4/113 (3.5%) died

Jensen (2013) Canada [64]

• Repeat access emergency healthcare – EMS (call or EMS run)

6/238 (2.5%) patients who received extended paramedic care but who were not transported subsequently triggered a EMS call <48 h

Kahalé (2006) Canada [65]

• Repeat access general healthcare – GP

• Repeat access general healthcare – walk-in clinic

• Repeat access emergency healthcare – ED

51/345 (14.8%) non-transported children were seen at the ED <48 h

Telephone follow-up with patients (n = 106) about additional care <48 h:

• 51/106 (48.1%) patients did not seek medical follow-up

• 28/106 (26.4%) patients went to the ED

• 22/106 (20.8%) patients visited the family physician/paediatrician office

• 4/106 (3.8%) patients visited a walk-in clinic

• 1/106 (0.9%) patients went to a hospital/outpatient clinic

Knight (2003) USA [37]

• Repeat access emergency healthcare – ED

• Repeat access emergency healthcare – EMS (call or EMS run)

• Patient outcome – mortality

• Patient outcome – hospitalization

3454/26574 (13.0%) follow-up was obtained <1 week:

• 174/3454 (5.0%) patients were admitted to the hospital

• 25/3454 (0.7%) patients died

• 465/3454 (13.5%) patient had an EMS dispatch

 ◦ < 3 years: 8/465 (1.7%)

 ◦ 3–12 years: 14/465 (3.0%)

 ◦ 13–17 years: 24/465 (5.2%)

 ◦ 18–64 years: 301/465 (64.7%)

 ◦ ≥ 65 years: 118/465 (25.4%)

• 2790/3454 (80.1%) of the patients had an ED visit

 ◦ < 3 years: 133/3454 (3.9%)

 ◦ 3–12 years: 175/3454 (5.1%)

 ◦ 13–17 years: 223/3454 (6.5%)

 ◦ 18–64 years: 2041/3454 (59.1%)

 ◦ ≥ 65 years: 218/3454 (6.3%)

• 174/3454 (5.0%) of the patients were admitted

 ◦ < 3 years: 12/174 (6.9%)

 ◦ 3–12 years: 13/174 (7.5%)

 ◦ 13–17 years: 7/174 (4.0%)

 ◦ 18–64 years: 97/174 (55.7%)

 ◦ ≥ 65 years: 45/174 (25.9%)

Lerner (2003) USA [66]

• Repeat access general healthcare – GP

• Repeat access emergency healthcare – ED

20/36 (55.6%) sought further medical assistance <48 h:

• 11/20 (55.0%) called their personal physician

• 8/20 (40.0%) visited their personal physician

• 1/20 (5.0%) went to the ED

Magnusson (2016) Sweden [38]

• Repeat access general healthcare – GP

• Repeat access emergency healthcare – ED

• Patient outcome – hospitalization

38/200 (19.0%) patients visited the ED <72 h:

• 24/38 (63.2%) self to ED

◦ 12/24 (50.0%) admitted

• 14/38 (36.8%) referred by GP

◦ 8/14 (57.1%) admitted

Mechem (1998) USA [67]

• Repeat access general healthcare – GP

• Repeat access emergency healthcare – ED

• Repeat access emergency healthcare – EMS (call or EMS run)

• Patient outcome – hospitalization

94/103 (91.3%) patients had no recurrence of symptoms in <72 h:

• 7/94 (7.4%) contacted private physician

9/103 (8.7%) recontacted the EMS < 72 h:

• 5/9 (55.6%) transported and released from ED

• 3/9 (33.3%) transported and admitted

• 1/9 (11.1%) refused transport

Mikolaizak (2013) Australia [26]

• Repeat access general healthcare – GP

• Repeat access general healthcare – walk-in clinic

• Repeat access emergency healthcare – ED

• Repeat access emergency healthcare – EMS (call or EMS run)

• Patient outcome – mortality

• Patient outcome – hospitalization

Follow-up periods varied from 1 to 12 months. Outcomes: 12%–49% readmission in ambulance or other health service facility, non-transported patients have significantly higher risk of death compared to age matched peers

Minhas (2015) Canada [39]

• Repeat access emergency healthcare – EMS (call or EMS run)

1/76 (1.3%) of the patients treated and released had 14 representations <72 h

Moss (1998) USA [40]

• Repeat access emergency healthcare – ED

• Repeat access emergency healthcare – EMS (call or EMS run)

• Patient outcome – mortality

• Patient outcome – hospitalization

431/443 (97.3%) patients a follow-up was obtained:

• 10/431 (2.3%) called EMS again <48 h

 ◦ 4/10 (40.0%) were admitted to a hospital

 ◦ 4/10 (40.0%) were discharged from the ED

 ◦ 1/10 (10.0%) died

 ◦ 1/10 (10.0%) was transferred to another facility

Persse (2002) USA [69]

• Patient outcome – hospitalization

Phase 1: 151/254 (59.5%) patients were contacted by telephone:

 • 56/151 (37.1%) sought further medical help <24 h

 • 19/151 (12.6%) were hospitalized

Phase 2: 109/198 (55.1%) patients were contacted by telephone:

 • 37/109 (33.9%) sought further medical help <24 h

 • 7/109 (6.4%) were hospitalized

Pringle (2005) USA [43]

• Patient outcome – mortality

• Patient outcome – hospitalization

310/906 (34.2%) follow-up was obtained (1 week):

 • 172/310 (55.5%) patients sought medical care:

  ◦ 106/172 (61.6%) medical care was changed

 • 25/310 (8.1%) were admitted to a hospital

 • 1/310 (0.3%) patients died

Rudolph (2011) Denmark [44]

• Patient outcome – mortality

18/2241 (0.8%) patients released on scene died <48 h

Schmidt (2006) USA [45]

• Patient outcome – mortality

2/128 (1.6%) patients not-transported died <30 days

Snooks (2004a) UK [28]

• Patient outcome – hospitalization

Intervention group: 5/93 (5.4%) patients were admitted to a hospital <14 days

Control group: 12/195 (6.2%) patients were admitted to a hospital <14 days

Socransky (1998) USA [48]

• Repeat access emergency healthcare – ED

• Patient outcome – hospitalization

• Patient outcome – recurrent symptoms

25/412 (6.1%) of the patients who refused transport had a relapse <48 h:

 • 14/25 (56.0%) refused transport again

 • 6/25 (24.0%) admitted to the ED

 • 5/25 (20.0%) were admitted to a hospital

Staudenmayer (2011) USA [50]

• Repeat access emergency healthcare – ED

• Patient outcome – hospitalization

• Patient outcome – mortality

1715/5865 (29.2%) follow-up obtained:

 • 1616/1715 (94.2%) patients were seen in the ED and discharged

 • 92/1715 (5.4%) were admitted to the hospital

 • 7/1715 (0.4%) died

Strote (2008) USA [75]

• Repeat access general healthcare – GP

• Repeat access emergency healthcare – ED

• Patient outcome – hospitalization

203/402 (49.5%) follow-up obtained:

 • 111/203 (54.7%) patients contacted their primary care physician <24 h

 • 8/203 (3.9%) patients called the EMS again <48 h

 • 16/203 (7.9%) patients went to the hospital <48 h

Tiedemann (2013) UK [76]

• Patient outcome – recurrent symptoms

62/251 (24.7%) of the non-transported patients required ≥1 fall related repeat ambulance attendance <6 months

Tohira (2016b) Australia [52]

• Repeat access emergency healthcare – ED

• Repeat access emergency healthcare – EMS (call or EMS run)

• Patient outcome – mortality

• Patient outcome – hospitalization

Subsequent events after discharge at the scene, Unadj OR (95% CI) ∗ Adj OR (95% CI)∗

Ambulance request

• Within 1 day 672/11096 (6.1%) 3.5 (3.1–4.0) 3.4 (3.0–3.9)

• Within 3 days 995/11096 (9.0%) 2.3 (2.1–2.5) 2.1 (1.9–2.4)

• Within 7 days 1305/11096 (11.8%) 1.9 (1.7–2.0) 1.7 (1.6–1.9)

ED attendance

• Within 1 day 514/11096 (4.6%) 3.4 (3.0–3.9) 3.3 (2.8–3.8)

• Within 3 days 710/11096 (6.4%) 2.0 (1.8–2.2) 1.9 (1.7–2.2)

• Within 7 days 898/11096 (8.1%) 1.5 (1.4–1.6) 1.4 (1.2–1.5)

Hospitalisation

• Within 1 day 361/11096 (3.3%) 4.1 (3.5–4.9) 4.2 (3.4–5.1)

• Within 3 days 500/11096 (4.5%) 2.5 (2.2–2.9) 2.3 (2.0–2.7)

• Within 7 days 634/11096 (5.7%) 2.0 (1.8–2.2) 1.8 (1.6–2.0)

Death

• Within 1 day 19/11096 (0.2%) 1.6 (0.9–2.8) 1.8 (0.99–3.2)

• Within 3 days 32/11096 (0.3%) 1.7 (1.1–2.6) 1.9 (1.2–3.0)

• Within 7 days 56/11096 (0.5%) 1.6 (1.2–2.3) 1.8 (1.3–2.5)

∗ vs. ED-discharge

Van der Pols (2011) The Netherlands [77]

• Repeat access general healthcare – GP

Motorcycle response vehicles with one ambulance nurse with additional training (n = 468) compared to regular ambulance (n = 1196):

 • referral to GP 138/468 (29.5%) vs 167/1196 (14.0%) RR 2.11 (95%CI 1.73–2.58)

Vilke (2002) USA [78]

• Repeat access general healthcare – GP

• Repeat access general healthcare – walk-in clinic

• Repeat access emergency healthcare – ED

• Repeat access emergency healthcare – EMS (call or EMS run)

71/121 (58.7%) follow-up was obtained:

 • 27/71 (38.0%) visited family physician

 • 25/71 (35.2) visited urgent care facility

 • 9/71 (12.7%) second EMS call and transported to ED

 • 9/71 (12.7%) transport to ED by private vehicle

 • 1/71 (1.4%) second EMS call and treated at scene

Zachariah (1992) USA [55]

• Repeat access general healthcare – GP

• Patient outcome – hospitalization

93/158 (58.9%) follow-up was obtained:

 • 60/93 (64.5%) sought care from a physician:

  ◦ 15/60 (25.0%) were admitted to hospital.