Epidemiological Determinants of Patient Non-Conveyance to the Hospital in an Emergency Medical Service Environment

Hassan Farhat, Cyrine Abid, Kawther El Aifa, Padarath Gangaram, Andre Jones, Mohamed Chaker Khenissi, Moncef Khadhraoui, Imed Gargouri, Loua Al-Shaikh, James Laughton, Guillaume Alinier, Paul B. Tchounwou (Editor)

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Abstract

Background: The increasing prevalence of comorbidities worldwide has spurred the need for time-effective pre-hospital emergency medical services (EMS). Some pre-hospital emergency calls requesting EMS result in patient non-conveyance. Decisions for non-conveyance are sometimes driven by the patient or the clinician, which may jeopardize the patients’ healthcare outcomes. This study aimed to explore the distribution and determinants of patient non-conveyance to hospitals in a Middle Eastern national Ambulance Service that promotes the transportation of all emergency call patients and does not adopt clinician-based non-conveyance decision. Methods: Using R Language, descriptive, bivariate, and binary logistic regression analyses were conducted for 334,392 multi-national patient non-conveyance emergency calls from June 2018 to July 2022, from a total of 1,030,228 calls to which a response unit was dispatched. Results: After data pre-processing, 237,862 cases of patient non-conveyance to hospital were retained, with a monthly average of 41.96% (n = 8799) of the emergency service demands and a standard deviation of 5.49% (n = 2040.63). They predominantly involved South Asians (29.36%, n = 69,849); 64.50% (n = 153,427) were of the age category from 14 to 44 years; 61.22% (n = 145,610) were male; 74.59% (n = 177,424) from the urban setting; and 71.28% (n = 169,552) had received on-scene treatment. Binary logistic regression with full variables and backward methods identified the final models of the determinants of patient non-conveyance decisions with an Akaike information criterion prediction estimator, respectively, of (250,200) and (250,169), indicating no significant difference between both models (Chi-square test; p-value = 0.63). Conclusions: Despite exercising a cautious protocol by encouraging patient transportation to hospital, patient non-conveyance seems to be a problem in the healthcare system that strains the pre-hospital medical response teams’ resources. Policies and regulations should be adopted to encourage individuals to access other primary care centers when required rather than draining emergency services for non-emergency situations.
Original languageEnglish
JournalInternational Journal of Environmental Research and Public Health (IJERPH)
Volume20
Issue number14
Early online date20 Jul 2023
DOIs
Publication statusE-pub ahead of print - 20 Jul 2023

Keywords

  • Middle East
  • emergency medical services
  • paramedics
  • pre-hospital environment
  • non-conveyance

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