de Loor Susanne E, Verheij Tessa, Karol Thomas, Cuppen Franciscus G M H M, van Dijk Frits, Goldstein Femke, Janssen Joyce, Ebben Remco H A
Emergency Medical Service, Public Health and Safety Region Gelderland-Midden, Arnhem, The Netherlands.
Scand J Trauma Resusc Emerg Med. 2025 Feb 1;33(1):17. doi: 10.1186/s13049-025-01332-3.
Non-conveyance is an increasing part of ambulance care and has to be safe. One of the indicators to measure safety is an ambulance re-contact within 72 h. However, solely measuring the percentage of re-contacts has limited validity as it lacks insight in actual reasons of an ambulance re-contact. Therefore, the aim of our study was to analyze the incidence, reasons and outcomes of ambulance re-contacts within 72 h after non-conveyance.
We conducted a one year (2022) retrospective study in one EMS region in the Netherlands. Medical records of all non-conveyance runs with a re-contact were analyzed using a framework to categorize re-contact reasons in illness-related, patient-related, professional-related, and unrelated. Re-contact outcomes were measured in terms of (non-)conveyance and mortality.
585/13.879 (4.2%) non-conveyance runs had a re-contact within 72 h. 547/585 (93.5%) re-contacts could be categorized with the framework. Re-contacts were related to the illness (n = 267, 48.8%), the patient (n = 130, 23.8%), the professional (n = 106, 19.4%) and unrelated (n = 44, 8.0%). Four subreasons accounted for 68.5% of reasons for re-contacts: progression of disease (19.4%), recurrent disease process/exacerbation (18.6%), reassessment and ambulance request by another medical professional (15.9%), and psychiatric disorder and/or substance abuse (14.6%). 403/547 (73.7%) patients with a re-contact were conveyed to the hospital. Mortality rate for patients with a re-contact was 0.5%.
Re-contact incidence after non-conveyance is relatively low, with a very small part of re-contacts related to ambulance care professionals making errors in diagnosis or treatment. Combined with low re-contact mortality, this indicates safe non-conveyance decisions. Re-contacts as quality indicator cover a variety of reasons, with almost half of the re-contacts being related to illness. Four subcategories accounted for the majority of all reasons for re-contacts: progression of disease, recurrent disease process/exacerbation, reassessment and ambulance request by another medical professional, and psychiatric disorder and/or substance abuse. Three-quarters of the patients were conveyed, although more re-contacts due to patient related reasons ended in non-conveyance again.
不转运是救护车医疗服务中越来越常见的一部分，且必须确保安全。衡量安全性的指标之一是72小时内救护车再次出诊。然而，仅衡量再次出诊的百分比有效性有限，因为它无法深入了解救护车再次出诊的实际原因。因此，我们研究的目的是分析不转运后72小时内救护车再次出诊的发生率、原因及结果。
我们在荷兰的一个急救医疗服务（EMS）区域进行了为期一年（2022年）的回顾性研究。使用一个框架对所有有再次出诊的不转运病例的医疗记录进行分析，该框架将再次出诊的原因分为与疾病相关、与患者相关、与专业相关和无关四类。再次出诊的结果通过（是否）转运和死亡率来衡量。
585/13879（4.2%）例不转运病例在72小时内有再次出诊。547/585（93.5%）例再次出诊可通过该框架进行分类。再次出诊与疾病（n = 267，48.8%）、患者（n = 130，23.8%）、专业人员（n = 106，19.4%）和无关因素（n = 44，8.0%）有关。四个子原因占再次出诊原因的68.5%：疾病进展（19.4%）、疾病复发/加重（18.6%）、另一名医疗专业人员的重新评估和救护车请求（15.9%）以及精神障碍和/或药物滥用（14.6%）。403/547（73.7%）例有再次出诊的患者被转运至医院。有再次出诊的患者死亡率为0.5%。
不转运后的再次出诊发生率相对较低，其中与救护车医护人员诊断或治疗错误相关的再次出诊占比很小。再加上再次出诊死亡率较低，这表明不转运决策是安全的。再次出诊作为质量指标涵盖了多种原因，其中近一半的再次出诊与疾病相关。四个子类别占所有再次出诊原因的大部分：疾病进展、疾病复发/加重、另一名医疗专业人员的重新评估和救护车请求以及精神障碍和/或药物滥用。四分之三的患者被转运，尽管因患者相关原因导致的再次出诊中更多最终再次未被转运。
