Epidemiological Determinants of Patient Non-Conveyance to the Hospital in an Emergency Medical Service Environment

Hassan Farhat; Cyrine Abid; Kawther El Aifa; Padarath Gangaram; Andre Jones; Mohamed Chaker Khenissi; Moncef Khadhraoui; Imed Gargouri; Loua Al-Shaikh; James Laughton; Guillaume Alinier

doi:10.3390/ijerph20146404

Epidemiological Determinants of Patient Non-Conveyance to the Hospital in an Emergency Medical Service Environment

Int J Environ Res Public Health. 2023 Jul 20;20(14):6404. doi: 10.3390/ijerph20146404.

Authors

Hassan Farhat^{1

2

3}, Cyrine Abid⁴, Kawther El Aifa¹, Padarath Gangaram^{1

5}, Andre Jones¹, Mohamed Chaker Khenissi¹, Moncef Khadhraoui⁶, Imed Gargouri⁴, Loua Al-Shaikh¹, James Laughton⁵, Guillaume Alinier^{1

7

8

9}

Affiliations

¹ Ambulance Service, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar.
² Faculty of Sciences, University of Sfax, Sfax P.O. Box 3000, Tunisia.
³ Faculty of Medicine "Ibn El Jazzar", University of Sousse, Sousse P.O. Box 4000, Tunisia.
⁴ Faculty of Medicine, University of Sfax, Sfax P.O. Box 3000, Tunisia.
⁵ Faculty of Health Sciences, Durban University of Technology, P.O. Box 1334, Durban 4000, South Africa.
⁶ Higher Institute of Biotechnology, University of Sfax, Sfax P.O. Box 3038, Tunisia.
⁷ School of Health and Social Work, University of Hertfordshire, Hatfield AL10 9AB, UK.
⁸ Weill Cornell Medicine-Qatar, Doha P.O. Box 24144, Qatar.
⁹ Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK.

Abstract

Background: The increasing prevalence of comorbidities worldwide has spurred the need for time-effective pre-hospital emergency medical services (EMS). Some pre-hospital emergency calls requesting EMS result in patient non-conveyance. Decisions for non-conveyance are sometimes driven by the patient or the clinician, which may jeopardize the patients' healthcare outcomes. This study aimed to explore the distribution and determinants of patient non-conveyance to hospitals in a Middle Eastern national Ambulance Service that promotes the transportation of all emergency call patients and does not adopt clinician-based non-conveyance decision.

Methods: Using R Language, descriptive, bivariate, and binary logistic regression analyses were conducted for 334,392 multi-national patient non-conveyance emergency calls from June 2018 to July 2022, from a total of 1,030,228 calls to which a response unit was dispatched.

Results: After data pre-processing, 237,862 cases of patient non-conveyance to hospital were retained, with a monthly average of 41.96% (n = 8799) of the emergency service demands and a standard deviation of 5.49% (n = 2040.63). They predominantly involved South Asians (29.36%, n = 69,849); 64.50% (n = 153,427) were of the age category from 14 to 44 years; 61.22% (n = 145,610) were male; 74.59% (n = 177,424) from the urban setting; and 71.28% (n = 169,552) had received on-scene treatment. Binary logistic regression with full variables and backward methods identified the final models of the determinants of patient non-conveyance decisions with an Akaike information criterion prediction estimator, respectively, of (250,200) and (250,169), indicating no significant difference between both models (Chi-square test; p-value = 0.63).

Conclusions: Despite exercising a cautious protocol by encouraging patient transportation to hospital, patient non-conveyance seems to be a problem in the healthcare system that strains the pre-hospital medical response teams' resources. Policies and regulations should be adopted to encourage individuals to access other primary care centers when required rather than draining emergency services for non-emergency situations.

Keywords: Middle East; emergency medical services; non-conveyance; paramedics; pre-hospital environment.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Ambulances
Emergency Medical Services*
Emergency Service, Hospital
Female
Hospitals
Humans
Male
Transportation of Patients
Young Adult

Grants and funding

Open Access funding was provided by Qatar National Library (OAF-8183). The funding sources did not play a role in the study design or execution.