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Abstract
Objectives An NHS England report highlighted key issues in how patients were initially navigating access to healthcare. This has manifested in increased pressure on ambulance services and emergency departments (EDs) to provide high quality, safe and efficient services to manage this demand. This study aims to identify non-urgent conveyances by ambulance services to the ED that would be suitable for care at scene or an alternative response.
Design A retrospective analysis of emergency department data linked to initial pre-hospital call data (either ‘111’ or ‘999’) in 2014 in Yorkshire and Humber. A previously validated definition of non-urgent attendance at ED was adapted for pre-hospital use to identify all linked ambulance conveyances that had no ‘in-hospital’ specific investigations, treatments or follow up care during that episode. Linked data was used to identify clinical triage conditions at the time and source of call (999 or 111).
Setting All 14 acute trusts (acute hospital and ambulance service) in Yorkshire and Humber.
Outcome and measures The number of non-urgent attendances to ED which were conveyed by ambulance was examined in terms of age, time of arrival, initial triage (AMPDS) and final ED diagnosis.
ED final diagnosis for avoidable conveyances (n=65,360)
Results 1,312,539 linked patient episodes were analysed which included ambulance service contact and hospital data. 4 04 348 (30.8%) of the total reported were transported by ambulance. Of all the linked conveyances, 65 360 (16.2%) were classed as non-urgent ED attendances. There were significantly increased odds of a non-urgent conveyance out of hours (OR:1.48; 95% CI:1.45 to 1.51). Of all conveyances of patients aged 16–34 (n=77,683), 24 443 (31.5%) patients were non-urgent. This compares with patients aged 75+ (n=150,668), in which 11 400 (7.1%) were considered non-urgent. 70.6% of the data was included for AMPDS analysis. This demonstrated the largest numbers of non-urgent conveyances (by code) came from falls (n=5277, 8.1%) and outside referrals such as ‘Healthcare Professionals’ (n=3983, 6.1%) and the ‘111 telephone service’ (n=9437, 14.4%). ED diagnosis analysis showed the highest proportion of patients were attending with minor injury and illness, and alcohol intoxication.
Conclusions 16% of ambulance conveyances to ED in 2014 were non-urgent with around 1 in 3 patients under the age of 34 conveyed with non-urgent complaints. 1 in 5 patients had a non-urgent conveyance out of hours. AMPDS analysis identified target areas for intervention including referrals from other healthcare providers. Final ED diagnosis identified specific patient target areas including minor illness and alcohol intoxication.
Age of patients taken to ED by ambulance (avoidable)