Paramedic Declination or Patient Refusal of EMS Transport: A Prospective Look at Medical Outcomes and Satisfaction

2.50
Hdl Handle:
http://hdl.handle.net/10755/162635
Type:
Presentation
Title:
Paramedic Declination or Patient Refusal of EMS Transport: A Prospective Look at Medical Outcomes and Satisfaction
Abstract:
Paramedic Declination or Patient Refusal of EMS Transport: A Prospective Look at Medical Outcomes and Satisfaction
Conference Sponsor:Emergency Nurses Association
Conference Year:1999
Author:Barbara, , Overby
Contact Address:University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599
Contact Telephone:USA
Co-Authors:Cliff Havenhouse, Jr., Jane H. Brice, Vicki J. Brkic, Amy Cates, Debbie Travers
Purpose: This study evaluated a unique emergency medical services (EMS) system in which paramedics may decline to transport a patient after on-scene evaluation and phone/radio consultation with a physician. The purpose of the study was to compare medical outcomes and satisfaction of declined patients to those patients who refused transportation.

Design/Setting: A prospective cross sectional design was used. This study was conducted in a county-based EMS system with approximately 9000 EMS calls annually, located in a suburban/rural area with a population of approximately 130,000 in a southeastern state.

Sample: All patients evaluated but not transported during a three-month period were included in the sample. Exclusion criteria included: (1) non-English speaking, (2) police custody, (3) pronounced dead, and (4) pediatric patients whose guardian was not present at the scene. Of 598 non-transported patients, 15% (n=91) of the patients met the exclusion criteria. An additional 37% (n=217) were excluded due to an inability to contact the patient or guardian (no contact after four phone attempts and survey mailed twice, invalid or no contact information reported, or mentally impaired). Of the remaining patients, 48% (n=290) were contacted and 9 refused to participate. The final sample included 200 patients who refused transportation and 81 who were declined transportation by the paramedics.

Methodology: A survey developed by the investigators using closed-ended and open-ended questions was used in a pilot study of 40 patients and modified for use in this study. Patients or guardians were surveyed by phone or mail (if necessary) to determine (1) further care obtained, (2) current condition, (3) overall satisfaction. Data were analyzed using descriptive and Chi-square statistics.

Results: There was no difference between the refusal and declined groups in further care obtained or current condition. Additionally, the two groups were similar in age and chief complaint. Statistical significance was achieved between the two groups in overall satisfaction with 6/200 (3%) refused patients and 8/81 (10%) declined patients were dissatisfied with their EMS care (p=.016).

Conclusions: Patients in both groups reported no negative medical outcomes. Even though overall satisfaction was different between the two groups, the numbers were small. The data suggest that patient declination may be safe, although more public education appears to be needed. [Research Paper Presentation]
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleParamedic Declination or Patient Refusal of EMS Transport: A Prospective Look at Medical Outcomes and Satisfactionen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162635-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Paramedic Declination or Patient Refusal of EMS Transport: A Prospective Look at Medical Outcomes and Satisfaction</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">1999</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Barbara, , Overby</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">USA</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Cliff Havenhouse, Jr., Jane H. Brice, Vicki J. Brkic, Amy Cates, Debbie Travers</td></tr><tr><td colspan="2" class="item-abstract">Purpose: This study evaluated a unique emergency medical services (EMS) system in which paramedics may decline to transport a patient after on-scene evaluation and phone/radio consultation with a physician. The purpose of the study was to compare medical outcomes and satisfaction of declined patients to those patients who refused transportation.<br/><br/>Design/Setting: A prospective cross sectional design was used. This study was conducted in a county-based EMS system with approximately 9000 EMS calls annually, located in a suburban/rural area with a population of approximately 130,000 in a southeastern state.<br/><br/>Sample: All patients evaluated but not transported during a three-month period were included in the sample. Exclusion criteria included: (1) non-English speaking, (2) police custody, (3) pronounced dead, and (4) pediatric patients whose guardian was not present at the scene. Of 598 non-transported patients, 15% (n=91) of the patients met the exclusion criteria. An additional 37% (n=217) were excluded due to an inability to contact the patient or guardian (no contact after four phone attempts and survey mailed twice, invalid or no contact information reported, or mentally impaired). Of the remaining patients, 48% (n=290) were contacted and 9 refused to participate. The final sample included 200 patients who refused transportation and 81 who were declined transportation by the paramedics.<br/><br/>Methodology: A survey developed by the investigators using closed-ended and open-ended questions was used in a pilot study of 40 patients and modified for use in this study. Patients or guardians were surveyed by phone or mail (if necessary) to determine (1) further care obtained, (2) current condition, (3) overall satisfaction. Data were analyzed using descriptive and Chi-square statistics.<br/><br/>Results: There was no difference between the refusal and declined groups in further care obtained or current condition. Additionally, the two groups were similar in age and chief complaint. Statistical significance was achieved between the two groups in overall satisfaction with 6/200 (3%) refused patients and 8/81 (10%) declined patients were dissatisfied with their EMS care (p=.016).<br/><br/>Conclusions: Patients in both groups reported no negative medical outcomes. Even though overall satisfaction was different between the two groups, the numbers were small. The data suggest that patient declination may be safe, although more public education appears to be needed. [Research Paper Presentation]</td></tr></table>en_GB
dc.date.available2011-10-27T10:31:32Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:31:32Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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