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Höglund, E., Magnusson, C., Lederman, J., Spangler, D., Vloet, L. & Ebben, R. (2024). Ambulance quality and outcome measures for general non-conveyed populations (AQUA): A scoping review. PLOS ONE, 19(8), Article ID e0306341.
Open this publication in new window or tab >>Ambulance quality and outcome measures for general non-conveyed populations (AQUA): A scoping review
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2024 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 19, no 8, article id e0306341Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND: An increasing number of patients receive ambulance care without being conveyed to a definitive care provider. This process has been described as complex, challenging, and lacking in guideline support by EMS clinicians. The use of quality- and outcome measures among non-conveyed patients is an understudied phenomenon.

AIM: To identify current quality- and outcome measures for the general population of non-conveyed patients in order to describe major trends and knowledge gaps.

METHODS: A scoping review of peer-reviewed original articles was conducted to identify quality- and outcome measures for non-conveyance within emergency medical services. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews statement (PRISMA-ScR) was followed. The PROSPERO and OSF database were checked for pending reviews or protocols. PubMed, CINAHL, Scopus, Web of Science and the Cochrane Library database were searched for relevant articles. Searches were performed in November 2023.

RESULTS: Thirty-six studies fulfilled the inclusion criteria and were included in the review. Mortality was the most used outcome measure, reported in 24 (67%) of the articles. Emergency department attendance and hospital admission were the following most used outcome measures. Follow-up durations varied substantially between both measures and studies. Mortality rates were found to have the longest follow-up times, with a median follow-up duration a little bit over one week.

CONCLUSIONS: This scoping review shows that studies report a wide range of quality and outcome measures in the ambulance setting to measure non-conveyance. Reported quality and outcome measures were also heterogeneous with regard to their follow-up timeframe. The variety of approaches to evaluate non-conveyance poses challenges for future research and quality improvement. A more uniform approach to reporting and measuring non-conveyance is needed to enable comparisons between contexts and formal meta-analysis.

Place, publisher, year, edition, pages
Public Library of Science (PLoS), 2024
National Category
Nursing
Identifiers
urn:nbn:se:oru:diva-115526 (URN)10.1371/journal.pone.0306341 (DOI)001295046300027 ()39163307 (PubMedID)2-s2.0-85201852014 (Scopus ID)
Available from: 2024-08-21 Created: 2024-08-21 Last updated: 2024-09-02Bibliographically approved
Viking, M., Hugelius, K., Höglund, E. & Kurland, L. (2024). One year cumulative incidence and risk factors associated with workplace violence within the ambulance service in a Swedish region: a prospective cohort study. BMJ Open, 14(9), Article ID e074939.
Open this publication in new window or tab >>One year cumulative incidence and risk factors associated with workplace violence within the ambulance service in a Swedish region: a prospective cohort study
2024 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 14, no 9, article id e074939Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To measure the 1 year cumulative incidence of and analyse the risk factors associated with workplace violence directed towards the ambulance service in a Swedish region. DESIGN: Prospective cohort study.

SETTING: The ambulance services in Örebro County Council (Sweden) contain approximately 300 000 inhabitants.

PARTICIPANTS: All ambulance missions during the period of 12 months (n=28 640) were assessed.

PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was workplace violence together with the associated risk factors.

RESULTS: The 1 year cumulative incidence of workplace violence within the ambulance service was 0.7%. Non-physical violence was most common. There was an increased odds for violence when the patient was under the influence of alcohol or drugs or suffering from mental illness. There was an association between the dispatch categories intoxication, unconsciousness or mental health problems and workplace violence against ambulance personnel. The offenders were mostly men aged 18-29 and workplace violence was more likely to occur in public places.

CONCLUSIONS: The 1 year cumulative incidence of workplace violence within the regional ambulance service was low in comparison to that of previous research. The overall regression model had low explanatory power, indicating that the phenomenon is complex and that additional variables need to be taken into account when trying to predict when workplace violence will occur. Additional research is needed to fully understand why workplace violence within the ambulance service occurs and how to mitigate such situations.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2024
Keywords
Accident & emergency medicine, health & safety, risk management
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-115797 (URN)10.1136/bmjopen-2023-074939 (DOI)001308921700001 ()39237282 (PubMedID)2-s2.0-85203419918 (Scopus ID)
Funder
Region Örebro County, OLL-960043Region Örebro County, OLL-934970Region Örebro County, OLL-933318
Note

This research received funding from the research committee of the county council of Örebro and Allmänna Läkarfonden.

Available from: 2024-09-06 Created: 2024-09-06 Last updated: 2024-09-19Bibliographically approved
Becker, J., Kurland, L., Höglund, E. & Hugelius, K. (2023). Dynamic ambulance relocation: a scoping review. BMJ Open, 13(12), Article ID e073394.
Open this publication in new window or tab >>Dynamic ambulance relocation: a scoping review
2023 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 12, article id e073394Article, review/survey (Refereed) Published
Abstract [en]

Objectives Dynamic ambulance relocation means that the operators at a dispatch centre place an ambulance in a temporary location, with the goal of optimising coverage and response times in future medical emergencies. This study aimed to scope the current research on dynamic ambulance relocation.

Design A scoping review was conducted using a structured search in PubMed, Scopus and Web of Science. In total, 21 papers were included.

Results Most papers described research with experimental designs involving the use of mathematical models to calculate the optimal use and temporary relocations of ambulances. The models relied on several variables, including distances, locations of hospitals, demographic-geological data, estimation of new emergencies, emergency medical services (EMSs) working hours and other data. Some studies used historic ambulance dispatching data to develop models. Only one study reported a prospective, real-time evaluation of the models and the development of technical systems. No study reported on either positive or negative patient outcomes or real-life chain effects from the dynamic relocation of ambulances.

Conclusions Current knowledge on dynamic relocation of ambulances is dominated by mathematical and technical support data that have calculated optimal locations of ambulance services based on response times and not patient outcomes. Conversely, knowledge of how patient outcomes and the working environment are affected by dynamic ambulance dispatching is lacking. This review has highlighted several gaps in the scientific coverage of the topic. The primary concern is the lack of studies reporting on patient outcomes, and the limited knowledge regarding several key factors, including the optimal use of ambulances in rural areas, turnaround times, domino effects and aspects of working environment for EMS personnel. Therefore, addressing these knowledge gaps is important in future studies.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2023
Keywords
accident & emergency medicine, organisation of health services, systematic review, health services administration & management
National Category
Nursing
Identifiers
urn:nbn:se:oru:diva-110434 (URN)10.1136/bmjopen-2023-073394 (DOI)001171839300004 ()2-s2.0-85179899873 (Scopus ID)
Available from: 2023-12-18 Created: 2023-12-18 Last updated: 2024-03-20Bibliographically approved
Höglund, E. (2022). Non-conveyance within the Swedish ambulance service: A prehospital patient safety study. (Doctoral dissertation). Örebro: Örebro University
Open this publication in new window or tab >>Non-conveyance within the Swedish ambulance service: A prehospital patient safety study
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

There is an increasing demand for ambulance services and more patients than before are requesting ambulance assistance for low acuity conditions. Ambulance services non-convey patients because they lack acute care needs. Non-conveying patients can be a person-centred, resource- and cost-efficient measure and can allow the ambulance to become available sooner for patients with more acute illnesses or injuries. However, validated non-conveyance guidelines are lacking and non-conveying patients raises patient safety issues.

Aim

The overarching aim of the research project was to describe the patients that were non-conveyed, to explore if there were any potential patient safety issues with the regional non-conveyance guidelines, and to describe how patients and nurses experience non-conveyance.

Methods

All non-conveyance assignments during one year in a region in Sweden (n=2691) were consecutively and prospectively included. The quantitative data was described, compared, and analysed (Studies I and II). Two interview studies were carried out. Phenomenography and conventional content analysis were used to analyse the qualitative data. In total 14 patients were interviewed in Study III and 20 nurses were interviewed in Study IV.

Conclusions

Patients of all ages with varying characteristics and complaints were non-conveyed. No patient received intensive care, and few were admitted to in-hospital care or died within seven days after being non-conveyed. Older age increases the risk of hospitalisation and death. Patients could feel ashamed for being non-conveyed, and the ambulance nurse could feel frustration when believing that the ambulance resource was misused

Place, publisher, year, edition, pages
Örebro: Örebro University, 2022. p. 84
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 258
Keywords
Ambulance, Ambulance nurse, Ambulance service, Emergency medical services, Non-conveyance, Non‐transport, Nurse, Patient, Patient assessment, Patient-safety
National Category
Other Health Sciences
Identifiers
urn:nbn:se:oru:diva-97614 (URN)9789175294339 (ISBN)
Public defence
2022-05-06, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2022-02-21 Created: 2022-02-21 Last updated: 2022-05-04Bibliographically approved
Höglund, E., Schröder, A., Andersson-Hagiwara, M., Möller, M. & Ohlsson-Nevo, E. (2022). Outcomes in patients not conveyed by emergency medical services (EMS): a one-year prospective study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 30(1), Article ID 40.
Open this publication in new window or tab >>Outcomes in patients not conveyed by emergency medical services (EMS): a one-year prospective study
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2022 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 30, no 1, article id 40Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The decision to not convey patients has become common in emergency medical services worldwide. A substantial proportion (12-51%) of the patients seen by emergency medical services are not conveyed by those services. The practice of non-conveyance is a result of the increasing and changing demands on the acute care system. Research focusing on the outcomes of the decision by emergency medical services to not convey patients is needed.

AIM: The aim was to describe outcomes (emergency department visits, admission to in-hospital intensive care units and mortality, all within seven days) and their association with the variables (sex, age, day of week, time of day, emergency signs and symptoms codes, triage level colour, and destination) for non-conveyed patients.

METHODS: This was a prospective analytical study with consecutive inclusion of all patients not conveyed by emergency medical services. Patients were included between February 2016 and January 2017. The study was conducted in Region Örebro county, Sweden. The region consists of both rural and urban areas and has a population of approximately 295,000. The region had three ambulance departments that received approximately 30,000 assignments per year.

RESULTS: The result showed that no patient received intensive care, and 18 (0.7%) patients died within seven days after the non-conveyance decision. Older age was associated with a higher risk of hospitalisation and death within seven days after a non-conveyance decision.

CONCLUSIONS: Based on the results of this one-year follow-up study, few patients compared to previous studies were admitted to the hospital, received intensive care or died within seven days. This study contributes insights that can be used to improve non-conveyance guidelines and minimise the risk of patient harm.

Place, publisher, year, edition, pages
BioMed Central, 2022
Keywords
Ambulance, Emergency medical services, Non-conveyance, Non-transport, Outcome measures, Quality, Triage
National Category
Nursing
Identifiers
urn:nbn:se:oru:diva-99611 (URN)10.1186/s13049-022-01023-3 (DOI)000810663900001 ()35698086 (PubMedID)2-s2.0-85131838754 (Scopus ID)
Note

Funding agency:

Research committee of the county council of Örebro OLL-942072 OLL-960656 OLL-840471

Available from: 2022-06-16 Created: 2022-06-16 Last updated: 2024-01-17Bibliographically approved
Malm, F., Elfstroem, A., Ohlsson Nevo, E. & Höglund, E. (2021). Time consumption for non-conveyed patients within emergency medical services (EMS): A one-year prospective descriptive and comparative study in a region of Sweden. PLOS ONE, 16(5), Article ID e0251686.
Open this publication in new window or tab >>Time consumption for non-conveyed patients within emergency medical services (EMS): A one-year prospective descriptive and comparative study in a region of Sweden
2021 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 16, no 5, article id e0251686Article in journal (Refereed) Published
Abstract [en]

Introduction: Over time, ambulance assignments have increased in number both nationally and internationally, and a substantial proportion of patients encountered by emergency medical services are assessed as not being in need of services. Non-conveying patients has become a way for emergency medical services clinicians to meet this increasing workload. It has been shown that ambulances can be made available sooner if patients are non-conveyed, but there is no previous research describing the factors that influence the non-conveyance time.

Study objective: To describe ambulance time consumption and the factors that influence time consumption when patients are non-conveyed.

Methods: A prospective observational review of 2615 non-conveyed patients' ambulance and hospital medical records was conducted using a consecutive sample. Data were analysed with the Kruskal-Wallis test, Mann-Whitney U test and Spearman's rank correlation (rho) for linear correlations.

Results: The mean NC time for all ambulance assignments during the study period was 26 minutes, with a median of 25 minutes. The shortest NC time was 4 minutes, and the longest NC time was 73 minutes. NC times were significantly faster during the day than at night.

Conclusions: This study provides new knowledge about time consumption when patients are non-conveyed. Although there are time differences when patients are non-conveyed, the differences observed in this study are small and not of clinical value. Ambulances will most often become available sooner if patients are non-conveyed. Although patients might be eligible for non-conveyance, policy-makers might have to decide when it is appropriate to non-convey patients from time, resource, patient safety and patient-centred care perspectives.

Place, publisher, year, edition, pages
PLOS, 2021
National Category
Nursing
Identifiers
urn:nbn:se:oru:diva-93403 (URN)10.1371/journal.pone.0251686 (DOI)000664628200115 ()33984054 (PubMedID)2-s2.0-85105803550 (Scopus ID)
Note

Funding agency:

Research Committee in the county council of Örebro

Available from: 2021-08-05 Created: 2021-08-05 Last updated: 2021-08-05Bibliographically approved
Höglund, E., Andersson-Hagiwara, M., Schröder, A., Möller, M. & Ohlsson Nevo, E. (2020). Characteristics of non-conveyed patients in emergency medical services (EMS): a one-year prospective descriptive and comparative study in a region of Sweden. BMC Emergency Medicine, 20(1), Article ID 61.
Open this publication in new window or tab >>Characteristics of non-conveyed patients in emergency medical services (EMS): a one-year prospective descriptive and comparative study in a region of Sweden
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2020 (English)In: BMC Emergency Medicine, E-ISSN 1471-227X, Vol. 20, no 1, article id 61Article in journal (Refereed) Published
Abstract [en]

Background: There has been an increasing demand for emergency medical services (EMS), and a growing number of patients are not conveyed; i.e., they are referred to levels of care other than ambulance conveyance to the emergency department. Patient safety issues have been raised regarding the ability of EMS to decide not to convey patients. To improve non-conveyance guidelines, information is needed about patients who are not conveyed by EMS. Therefore, the purpose of this study was to describe and compare the proportion and characteristics of non-conveyed EMS patients, together with assignment data.

Methods: A descriptive and comparative consecutive cohort design was undertaken. The decision of whether to convey patients was made by EMS according to a region-specific non-conveyance guideline. Non-conveyed patients' medical record data were prospectively gathered from February 2016 to January 2017. Analyses was conducted using the chi-squared test, two-sample t test, proportion test and Mann-Whitneys U-test.

Results: Out of the 23,250 patients served during the study period, 2691 (12%) were not conveyed. For non-conveyed adults, the most commonly used Emergency Signs and Symptoms (ESS) codes were unspecific symptoms/malaise, abdomen/flank/groin pain, and breathing difficulties. For non-conveyed children, the most common ESS codes were breathing difficulties and fever of unclear origin. Most of the non-conveyed patients had normal vital signs. Half of all patients with a designated non-conveyance level of care were referred to self-care. There were statistically significant differences between men and women.

Conclusions: Fewer patients were non-conveyed in the studied region compared to national and international non-conveyance rates. The differences seen between men and women were not of clinical significance. Follow-up studies are needed to understand what effect patient outcome so that guidelines might improve.

Place, publisher, year, edition, pages
BMC, 2020
Keywords
Ambulance, Emergency medical services, Non-conveyance, Non-transport, Triage
National Category
Anesthesiology and Intensive Care Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:oru:diva-85430 (URN)10.1186/s12873-020-00353-8 (DOI)000561221600001 ()32778074 (PubMedID)2-s2.0-85089323531 (Scopus ID)
Note

Funding Agency:

Research Committee in the county council of Örebro  OLL-674451 OLL-767301 OLL-811401 OLL-840471

Available from: 2020-09-04 Created: 2020-09-04 Last updated: 2024-07-04Bibliographically approved
Jacobsson, A., Kurland, L. & Höglund, E. (2020). Direct in-hospital admission via ambulance (DIVA): A retrospective observational study. International Emergency Nursing, 52, Article ID 100906.
Open this publication in new window or tab >>Direct in-hospital admission via ambulance (DIVA): A retrospective observational study
2020 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 52, article id 100906Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Prolonged stays in emergency departments increase the risk of adverse events in elderly patients. To optimize care for nonurgent patients who need in-hospital admission, a patient-focused improvement project named Direct In-hospital admission Via Ambulance (DIVA) was launched at Örebro University Hospital.

PURPOSE: This study describes the effects of DIVA. The primary outcome was time to in-hospital admission. Secondary outcomes were the in-hospital admission rate, the in-hospital length of stay and patient characteristics.

METHOD: This was a retrospective observational study. Descriptive and comparative statistics were used. All patients identified by the ambulance nurse as nonurgent but with an apparent need for in-hospital admission were candidates for direct in-hospital admission. The results were compared with those of a reference group.

RESULT: In total, 127 patients were included, with 45 patients in the DIVA group and 82 patients in the reference group. In the DIVA group, 24 patients were directly admitted. The median time to in-hospital admisson was 49.5 min for direct admitted patients and 278.5 min for the reference group. There was a statistical significant difference between the groups (p < 0.01).

CONCLUSION: The current study indicates that time to in-hospital admission could be reduced by DIVA.

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
Ambulance, Ambulance nurse, DIVA, Direct in-hospital admission, Patients, Time to in-hospital admission
National Category
Social and Clinical Pharmacy
Identifiers
urn:nbn:se:oru:diva-85127 (URN)10.1016/j.ienj.2020.100906 (DOI)000569480200009 ()32827937 (PubMedID)2-s2.0-85089463116 (Scopus ID)
Note

Funding Agencies:

Research Committee of the county council of Örebro  

Department of Emergency Care at Örebro University Hospital, Sweden  

Available from: 2020-09-07 Created: 2020-09-07 Last updated: 2024-01-16Bibliographically approved
Höglund, E., Schröder, A., Möller, M., Andersson-Hagiwara, M. & Ohlsson Nevo, E. (2019). The ambulance nurse experiences of non-conveying patients. Journal of Clinical Nursing, 28(1-2), 235-244
Open this publication in new window or tab >>The ambulance nurse experiences of non-conveying patients
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2019 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 28, no 1-2, p. 235-244Article in journal (Refereed) Published
Abstract [en]

AIMS AND OBJECTIVES: To explore ambulance nurses' (ANs) experiences of non-conveying patients to alternate levels of care.

BACKGROUND: Increases in ambulance utilisation and in the number of patients seeking ambulance care who do not require medical supervision or treatment during transport have led to increased nonconveyance (NC) and referral to other levels of care.

DESIGN: A qualitative interview study was conducted using an inductive research approach.

METHODS: The study was conducted in a region in the middle of Sweden during 2016-2017. Twenty nurses were recruited from the ambulance departments in the region. A conventional content analysis was used to analyse the interviews. The study followed the COREQ checklist.

RESULTS: The ANs experienced NC as a complex and difficult task that carried a large amount of responsibility. They wanted to be professional, spend time with the patient and find the best solution for him or her. These needs conflicted with the ANs' desire to be available for assignments with a higher priority. The ANs could feel frustrated when they perceived that ambulance resources were being misused and when it was difficult to follow the NC guidelines.

CONCLUSION: If ANs are expected to nonconvey patients seeking ambulance care, they need a formal mandate, knowledge and access to primary health care.

RELEVANCE TO CLINICAL PRACTICE: This study provides new knowledge regarding the work situation of ANs in relation to NC. These findings can guide future research and can be used by policymakers and ambulance organisations to highlight areas that need to evolve to improve patient care.

Place, publisher, year, edition, pages
Blackwell Science Ltd., 2019
Keywords
ambulance nursing, care pathways, clinical decision-making, content analysis, experiences, health services research, nurse, qualitative study, refusal of care, self-care
National Category
Nursing
Identifiers
urn:nbn:se:oru:diva-71216 (URN)10.1111/jocn.14626 (DOI)000453228000022 ()30016570 (PubMedID)2-s2.0-85052619602 (Scopus ID)
Note

Funding Agency:

Research Committee in the county council of Örebro OLL-590171  OLL-670821  OLL-767261

Available from: 2019-01-08 Created: 2019-01-08 Last updated: 2022-05-04Bibliographically approved
Höglund, E., Schröder, A., Möller, M., Hagiwara, M. & Ohlsson Nevo, E. (2018). Ambulance nurses experiences of non-conveying patients to another level of care. In: : . Paper presented at Forskningens och utvecklingens dag 2018, Örebro, Sweden, 12 April, 2018.
Open this publication in new window or tab >>Ambulance nurses experiences of non-conveying patients to another level of care
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2018 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Medical and Health Sciences Nursing
Identifiers
urn:nbn:se:oru:diva-77568 (URN)
Conference
Forskningens och utvecklingens dag 2018, Örebro, Sweden, 12 April, 2018
Available from: 2019-10-24 Created: 2019-10-24 Last updated: 2020-12-01Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-7885-694X

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