Paulin Jani, Saari Teijo I, Riihimäki Heikki, Koivisto Mari, Peltonen Laura-Maria
Turku University of Applied Sciences and University of Turku, Turku, Finland.
Department of Anaesthesiology and Intensive Care, Division of Perioperative Services, Intensive Care and Pain Medicine, University of Turku, Turku University Hospital, Turku, Finland.
Scand J Trauma Resusc Emerg Med. 2025 Apr 9;33(1):60. doi: 10.1186/s13049-025-01378-3.
Emergency Medical Services (EMS) and Emergency Departments (ED) have reported increased patient volumes in the last decades. Despite high rates of non-conveyance decisions, unnecessary conveyances by EMS still occur. The aim of this study was to explore care pathways of conveyed patients by EMS through registry data.
This was a retrospective cohort study of EMS patients in Finland. The primary outcomes were EMS recontacts and visits to a primary health care facility or ED within seven days. The secondary outcome was mortality within one week. Univariate and multivariable associations between the outcome variables and categorical variables were analysed with logistic regression. Results are presented with odds ratios (ORs) together with 95% confidence intervals (CIs) and p-values.
The conveyed patients' visits to health care facilities were mainly brief. EMS arrival during night-time (20:00-08:00) (OR 1.69; 95% CI 1.59 to 1.80), in urban area (OR 1.21; 95% CI 1.13 to 1.29) and alcohol use (OR 2.55; 95% CI 2.26 to 2.86) predicted short ED visits (< 24 h). 77% of the patients were discharged from primary health care within one hour (median 22 min, IQR 18-60). After EMS conveyance and visit to the ED or primary health care facility, 10.5% of the patients were readmitted within one week. Non-urgent patients (OR 1.26; 95% CI 1.14 to 1.39), an EMS mission at night (OR 1.36; 95% CI 1.24 to 1.50), and based on univariate analyses, the usage of alcohol (OR 1.26; 95% CI 1.09 to 1.45) increased the likelihood of a readmission. 449 patients of all conveyed EMS patients (n = 20376) died within one week (2.2%).
EMS non-conveyance reduces patient flow in EDs, but there is a possibility that more could be done related to unnecessary conveyances to health care facilities, especially in urban areas and at night. The pathway analyses of post conveyance re-contacts show that a small number of patients burden the system. Further in-depth studies are needed to understand of unnecessary conveyances, find solutions, and provide repeated users the appropriate care.
紧急医疗服务（EMS）和急诊科（ED）报告称，在过去几十年中患者数量有所增加。尽管非转运决策的比例很高，但EMS仍会出现不必要的转运情况。本研究的目的是通过登记数据探索EMS转运患者的护理路径。
这是一项对芬兰EMS患者的回顾性队列研究。主要结局是EMS再次接触以及在7天内到初级卫生保健机构或急诊科就诊。次要结局是一周内的死亡率。使用逻辑回归分析结局变量与分类变量之间的单变量和多变量关联。结果以比值比（OR）以及95%置信区间（CI）和p值呈现。
转运患者到医疗机构的就诊主要是短暂的。夜间（20:00 - 08:00）EMS到达（OR 1.69；95% CI 1.59至1.80）、在城市地区（OR 1.21；95% CI 1.13至1.29）以及饮酒（OR 2.55；95% CI 2.26至2.86）预示着急诊科就诊时间短（<24小时）。77%的患者在1小时内从初级卫生保健机构出院（中位数22分钟，四分位间距18 - 60）。在EMS转运并到急诊科或初级卫生保健机构就诊后，10.5%的患者在一周内再次入院。非紧急患者（OR 1.26；95% CI 1.14至1.39）、夜间的EMS任务（OR 1.36；95% CI 1.24至1.50），并且基于单变量分析，饮酒（OR 1.26；95% CI 1.09至1.45）增加了再次入院的可能性。在所有转运的EMS患者（n = 20376）中，449名患者在一周内死亡（2.2%）。
EMS不转运可减少急诊科的患者流量，但对于不必要地转运至医疗机构，尤其是在城市地区和夜间，可能还有更多工作可做。转运后再次接触的路径分析表明少数患者给系统带来负担。需要进一步深入研究以了解不必要的转运情况、找到解决方案，并为重复使用者提供适当的护理。
