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Abstract
Background The decision over whether to convey after emergency ambulance attendance plays a vital role in preventing avoidable admissions to a hospital’s emergency department (ED). This is especially important with the elderly, for whom the likelihood and frequency of adverse events are greatest.
Objective To provide a structured overview of factors influencing the conveyance decision of elderly people to the ED after emergency ambulance attendance, and the outcomes of these decisions.
Data sources A mixed studies review of empirical studies was performed based on systematic searches, without date restrictions, in PubMed, CINAHL and Embase (April 2018). Twenty-nine studies were included.
Study eligibility criteria Only studies with evidence gathered after an emergency medical service (EMS) response in a prehospital setting that focused on factors that influence the decision whether to convey an elderly patient were included.
Setting Prehospital, EMS setting; participants to include EMS staff and/or elderly patients after emergency ambulance attendance.
Study appraisal and synthesis methods The Mixed Methods Appraisal Tool was used in appraising the included articles. Data were assessed using a ‘best fit’ framework synthesis approach.
Results ED referral by EMS staff is determined by many factors, and not only the acuteness of the medical emergency. Factors that increase the likelihood of non-conveyance are: non-conveyance guidelines, use of feedback loop, the experience, confidence, educational background and composition (male–female) of the EMS staff attending and consulting a physician, EMS colleague or other healthcare provider. Factors that boost the likelihood of conveyance are: being held liable, a lack of organisational support, of confidence and/or of baseline health information, and situational circumstances. Findings are presented in an overarching framework that includes the impact of these factors on the decision’s outcomes.
Conclusion Many non-medical factors influence the ED conveyance decision after emergency ambulance attendance, and this makes it a complex issue to manage.
- decision making
- emergency medical service
- aged
- mixed atudies review
- conveyance/non-conveyance
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Footnotes
Contributors All the authors contributed to the study design. Data were collected and selected by JO, DS and MB. Critical appraisal of all the selected articles was divided among PR, DS and MB. JO independently reviewed all the articles and results were compared. Agreement on a definitive appraisal was obtained by discussion. The manuscript was drafted by JO in close collaboration with MB and SB. All the authors approved the final manuscript before submitting.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Additional documentation on the data-collection process and appraisal is available from the corresponding author on reasonable request.