Ambulance over-conveyance to the emergency department: a large data analysis of ambulance journeys

Abstract

Aim Over-conveyance by the ambulance service is a compounding factor of emergency department (ED) crowding. Previous solutions have focused on specific patient groups which have a limited impact when compared to the whole urgent and emergency care system. This study aims to analyse nonurgent conveyances by the ambulance service that could be suitable for discharge on-scene. Results We analysed a dataset of 1,312,539 patient episodes which linked all pre-hospital emergency and urgent calls to subsequent ED attendance in 2014. The study was set in a large region in England (total population 5.3 million). As well as proportion of avoidable conveyances we also examined the association with patient age, time of arrival, re-attendance and initial triage code from ambulance dispatch. Results There were 4 04 348 (30.8%) patients transported to ED by ambulance and of these 66 220 (16.4%) were considered potentially avoidable. There were significantly increased odds of a non-urgent conveyance out of hours (OR 1.44, 95% CI: 1.41 to 1.46). Patients aged 16–34 had the largest proportion of avoidable conveyances with 24 500 (37%). There were 13 625 (21%) episodes that were received from another healthcare professional or urgent telephone number. When analysing ED diagnosis, the highest proportion were attending with minor injury and illness, and alcohol intoxication. Abstracts A22 BMJ Open 2018;8(Suppl 1):A1–A34 Trust (NHS). Protected by copyright. on 14 August 2019 at Manchester University NHS Foundation http://bmjopen.bmj.com/ BMJ Open: first published as 10.1136/bmjopen-2018-EMS.59 on 16 April 2018. Downloaded from Conclusion One in six ambulance conveyances to ED were deemed non-urgent. The younger population had the largest amount of preventable conveyance by ambulance with diagnoses which could be treated and discharged on-scene. Pathways and interventions would provide a larger patient benefit if they were designed around patient populations as opposed to disease specific https://bmjopen.bmj.com/content/8/Suppl_1/A22.3 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/bmjopen-2018-EMS.59