Skip to main content

Table 3 Follow-up care after non-conveyance

From: A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review

1st author (year) Country [ref] Follow-up outcomes Results
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.