Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 147 No. 4748 (2017)

Risk of adverse outcome in patients referred by emergency medical services in Switzerland

  • Tito Bosia
  • Alexandra Malinovska
  • Karin Weigel
  • Fabrizia Schmid
  • Christian H. Nickel
  • Roland Bingisser
DOI
https://doi.org/10.4414/smw.2017.14554
Cite this as:
Swiss Med Wkly. 2017;147:w14554
Published
23.11.2017

Summary

AIMS OF THE STUDY

Comparison of outcomes between different emergency medical services (EMS) is difficult and lacking in Switzerland. Therefore, knowledge about the inherent risks of EMS-referred patients is important. Targeted interventions may benefit these patients by optimising resource allocation. We therefore aimed to study outcomes in EMS-referred patients presenting to a Swiss emergency department (ED).

METHODS

Prospective observational study in all patients presenting to the ED of Basel University Hospital. Mode of referral was recorded (EMS or other). Univariate and multivariate linear, Poisson and logistic regression models were used. Crude and age/gender adjusted associations between mode of referral and outcomes were calculated. Outcomes were shown for admission, length of stay (LOS), in-hospital, and 1-year mortality.

RESULTS

Of 5634 patients presenting in the inclusion period, 4703 were screened, 4544 were included and 4287 were followed up for 365 days. Associations between EMS referral and several adverse outcomes were found and expressed as odds ratios (ORs) and geometric mean ratios (GMRs): hospital admission (OR 3.8, 95% CI 3.2–4.5; p <0.001), intensive care unit (ICU) admission (OR 4.2, 95% CI 3.2–5.5, p <0.001), ED-LOS (GMR 1.2, 95% CI 1.1–1.2; p <0.001), in-hospital mortality (OR 6.4, 95% CI 2.9–15.6; p <0.001) and 1-year mortality (OR 2.3, 95% CI 1.7–3.0; p <0.001).

CONCLUSION

Patients referred by EMS have higher odds of admission to hospital and ICU, a longer ED LOS, and higher short- and long-term mortalities than the general ED population.

References

  1. Ro YS, Shin SD, Song KJ, Cha WC, Cho JS. Triage-based resource allocation and clinical treatment protocol on outcome and length of stay in the emergency department. Emerg Med Australas. 2015;27(4):328–35. doi:.https://doi.org/10.1111/1742-6723.12426
  2. Wiler JL, Gentle C, Halfpenny JM, Heins A, Mehrotra A, Mikhail MG, et al. Optimizing emergency department front-end operations. Ann Emerg Med. 2010;55(2):142–160.e1. doi:.https://doi.org/10.1016/j.annemergmed.2009.05.021
  3. Lauks J, Mramor B, Baumgartl K, Maier H, Nickel CH, Bingisser R. Medical Team Evaluation: Effect on Emergency Department Waiting Time and Length of Stay. PLoS One. 2016;11(4):e0154372. doi:.https://doi.org/10.1371/journal.pone.0154372
  4. Nestler DM, Fratzke AR, Church CJ, Scanlan-Hanson L, Sadosty AT, Halasy MP, et al. Effect of a physician assistant as triage liaison provider on patient throughput in an academic emergency department. Acad Emerg Med. 2012;19(11):1235–41. doi:.https://doi.org/10.1111/acem.12010
  5. Soremekun OA, Capp R, Biddinger PD, White BA, Chang Y, Carignan SB, et al. Impact of physician screening in the emergency department on patient flow. J Emerg Med. 2012;43(3):509–15. doi:.https://doi.org/10.1016/j.jemermed.2012.01.025
  6. Grossmann FF, Nickel CH, Christ M, Schneider K, Spirig R, Bingisser R. Transporting clinical tools to new settings: cultural adaptation and validation of the Emergency Severity Index in German. Ann Emerg Med. 2011;57(3):257–64. doi:.https://doi.org/10.1016/j.annemergmed.2010.07.021
  7. Ruger JP, Richter CJ, Lewis LM. Clinical and economic factors associated with ambulance use to the emergency department. Acad Emerg Med. 2006;13(8):879–85. doi:.https://doi.org/10.1111/j.1553-2712.2006.tb01742.x
  8. Anselmi L, Meacock R, Kristensen S, Doran T, Sutton M. Arrival by ambulance explains variation in mortality by time of admission: retrospective study of admissions to hospital following emergency department attendance in England. BMJ Qual Saf. 2017;26(8):613–21.
  9. Marinovich A, Afilalo J, Afilalo M, Colacone A, Unger B, Giguère C, et al. Impact of ambulance transportation on resource use in the emergency department. Acad Emerg Med. 2004;11(3):312–5. doi:.https://doi.org/10.1111/j.1553-2712.2004.tb02218.x
  10. Downing A, Wilson RC, Cooke MW. Which patients spend more than 4 hours in the Accident and Emergency department? J Public Health (Oxf). 2004;26(2):172–6. doi:.https://doi.org/10.1093/pubmed/fdh141
  11. Herlitz J, Hjälte L, Karlson BW, Suserud BO, Karlsson T. Characteristics and outcome of patients with acute chest pain in relation to the use of ambulances in an urban and a rural area. Am J Emerg Med. 2006;24(7):775–81. doi:.https://doi.org/10.1016/j.ajem.2006.03.016
  12. Herlitz J, Karlson BW, Bång A, Lindqvist J. Characteristics and outcome for patients with acute chest pain in relation to whether or not they were transported by ambulance. Eur J Emerg Med. 2000;7(3):195–200. doi:.https://doi.org/10.1097/00063110-200009000-00006
  13. Boothroyd LJ, Lambert LJ, Segal E, Ross D, Kouz S, Maire S, et al. Comparison of outcomes of ambulance users and nonusers in ST elevation myocardial infarction. Am J Cardiol. 2014;114(9):1289–94. doi:.https://doi.org/10.1016/j.amjcard.2014.07.060
  14. Worster A, Bledsoe RD, Cleve P, Fernandes CM, Upadhye S, Eva K. Reassessing the methods of medical record review studies in emergency medicine research. Ann Emerg Med. 2005;45(4):448–51. doi:.https://doi.org/10.1016/j.annemergmed.2004.11.021
  15. Rohacek M, Nickel CH, Dietrich M, Bingisser R. Clinical intuition ratings are associated with morbidity and hospitalisation. Int J Clin Pract. 2015;69(6):710–7. doi:.https://doi.org/10.1111/ijcp.12606
  16. Groenewoudt M, Roest AA, Leijten FM, Stassen PM. Septic patients arriving with emergency medical services: a seriously ill population. Eur J Emerg Med. 2014;21(5):330–5. doi:.https://doi.org/10.1097/MEJ.0000000000000091
  17. Durant E, Fahimi J. Factors associated with ambulance use among patients with low-acuity conditions. Prehosp Emerg Care. 2012;16(3):329–37. doi:.https://doi.org/10.3109/10903127.2012.670688
  18. So DY, Ha AC, Turek MA, Maloney JP, Higginson LA, Davies RF, et al. Comparison of mortality patterns in patients with ST-elevation myocardial infarction arriving by emergency medical services versus self-transport (from the prospective Ottawa Hospital STEMI Registry). Am J Cardiol. 2006;97(4):458–61. doi:.https://doi.org/10.1016/j.amjcard.2005.08.069
  19. Huber S, Crönlein M, von Matthey F, Hanschen M, Seidl F, Kirchhoff C, et al.; TraumaRegister DGU. Effect of private versus emergency medical systems transportation in trauma patients in a mostly physician based system- a retrospective multicenter study based on the TraumaRegister DGU®. Scand J Trauma Resusc Emerg Med. 2016;24(1):60. doi:.https://doi.org/10.1186/s13049-016-0252-1
  20. Johansson I, Strömberg A, Swahn E. Ambulance use in patients with acute myocardial infarction. J Cardiovasc Nurs. 2004;19(1):5–12. doi:.https://doi.org/10.1097/00005082-200401000-00004
  21. Richards JR, Ferrall SJ. Inappropriate use of emergency medical services transport: comparison of provider and patient perspectives. Acad Emerg Med. 1999;6(1):14–20. doi:.https://doi.org/10.1111/j.1553-2712.1999.tb00088.x
  22. Horibata K, Takemura Y. Inappropriate use of ambulance services by elderly patients with less urgent medical needs. Tohoku J Exp Med. 2015;235(2):89–95. doi:.https://doi.org/10.1620/tjem.235.89
  23. Toloo GS, FitzGerald GJ, Aitken PJ, Ting JYS, McKenzie K, Rego J, et al. Ambulance use is associated with higher self-rated illness seriousness: user attitudes and perceptions. Acad Emerg Med. 2013;20(6):576–83. doi:.https://doi.org/10.1111/acem.12149
  24. Nickel CH, Ruedinger J, Misch F, Blume K, Maile S, Schulte J, et al. Copeptin and peroxiredoxin-4 independently predict mortality in patients with nonspecific complaints presenting to the emergency department. Acad Emerg Med. 2011;18(8):851–9. doi:.https://doi.org/10.1111/j.1553-2712.2011.01126.x
  25. Gorski JK, Batt RJ, Otles E, Shah MN, Hamedani AG, Patterson BW. The Impact of Emergency Department Census on the Decision to Admit. Acad Emerg Med. 2017;24(1):13–21.
  26. Fogarty EM, Cummins F. The effect of admitted patients in the emergency department on rates of hospital admissions. Emerg Med J. 2013;30(9):766–7. doi:.https://doi.org/10.1136/emermed-2012-201780
  27. Dinh MM, Berendsen Russell S, Bein KJ, Chalkley D, Muscatello D, Paoloni R, et al. Trends and characteristics of short-term and frequent representations to emergency departments: A population-based study from New South Wales, Australia. Emerg Med Australas. 2016;28(3):307–12. doi:.https://doi.org/10.1111/1742-6723.12582