Against All Advice: An Analysis of Out-of-Hospital Refusals of Care

Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA.
Annals of Emergency Medicine (Impact Factor: 4.68). 12/2003; 42(5):689-96. DOI: 10.1016/S0196064403005249
Source: PubMed


We examine the characteristics of patients involved in out-of-hospital emergency medical services (EMS) incidents that result in refusal of care and determine the rates of subsequent EMS, emergency department (ED), and inpatient care, as well as death within 7 days.
Utah statewide EMS data identifying refusals of care were probabilistically linked to Utah statewide ED, inpatient, and death certificate data within 7 days of the initial EMS refusals for 1996 to 1998. Refusals were defined as incidents in which field treatment or transport was refused and did not include incidents in which EMS providers deemed care or transport unnecessary.
Of 277244 EMS incidents, 14109 (5.1%) resulted in refusals of care. For all age groups, motor vehicle crash dispatches resulted in the highest rate of refusal of care, ranging from 8.0% to 11.7%. Slightly more than 3% of patients involved in a refusal of care incident had a subsequent EMS dispatch within a week. One fifth of the patients involved in EMS refusals of care had a subsequent ED visit. Less than 2% of the EMS refusal patients were hospitalized; hospitalization was highest among children younger than 3 years and adults older than 64 years. Twenty-five adults died within a week of refusing EMS care, of whom 19 (76.0%) were older than 64 years.
Refusal of care incidents are a small segment of all EMS incidents. They arise from a variety of situations, and the risk for missed intervention may be minimal.

4 Reads
  • Source
    • "Of course, patients then have the right to receiving treatment and transportation or refuse one or both, against the advice of the treating paramedic (AMA). Treatment refusal rates range from 5% and 15%, in many studies [1–3]. Refusal of care or transport may happen for many reasons such as the patient not feeling they need further care and financial restraints. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective. Elderly patients are becoming an increasingly larger proportion of our population, and there is a paucity of data regarding the epidemiology of geriatric patients refusing transport. Treatment refusal rates range from 5% to 15% in many studies. This study sought to test the hypothesis that geriatric patients constituted an increasing proportion of those persons refusing prehospital transport. Methods. This study was a retrospective analysis of data from a query of a large urban EMS service. Results. There were a total of 22,347 adult transport refusals recorded during the 16-month study period. Multivariate logistic regression incorporating covariates for sex, race, season, chief complaint, metropolitan region, and whether any treatment occurred prior to transport refusal confirmed the increasing likelihood of Period 2 patients being geriatric, as compared with Period 1 (OR 1.24, 95% CI 1.14-1.35, Wald P < .001). Conclusion. This data shows that despite controlling for these covariates, patients refusing transport in the second period of this study were nearly 25% more likely to be geriatric as compared to those in the initial 8 months of the study.
    02/2012; 2012:905976. DOI:10.1155/2012/905976
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Emergency medical services (EMS) research is frequently dependent on data recorded by prehospital personnel. Linking EMS information with hospital outcome depends on essential identifying data. We sought to determine the accuracy of these data in patients who activated EMS for chest pain and to describe the types of errors committed. We performed a retrospective, consecutive case series study of all prehospital records for patients transported by the City of Pittsburgh Bureau of EMS (annual call volume, 60,000) for chest pain to three area hospitals during a three-month interval. Demographic data, including name, date of birth (DOB), and Social Security number (SSN), for each patient were extracted from the EMS record. These were compared to the definitive information in the hospital records. 360 prehospital records were examined, with 341 matches to hospital records. The correct patient name was recorded in 301 records (83.6%), the correct DOB was recorded 284 times (78.9%), and the correct SSN was recorded 120 times (33.3%). The overall error rate of demographic data recorded on EMS records was 73.9% (266/360). If SSN is not included as a demographic variable, then the overall error rate was 25.3% (91/360). The use of EMS-generated demographic data demonstrates moderate agreement and linkage with hospital records. Name and DOB are more reliable data elements for matching than SSN. Future research should examine the impact of electronic medical records and EMS identification numbers on data reliability.
    Prehospital Emergency Care 07/2009; 12(2):187-91. DOI:10.1080/10903120801907687 · 1.76 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To characterize older adult emergency department (ED) visits arriving by emergency medical services (EMS) and to identify factors associated with those patient visits. A secondary analysis of the ED component of the 1997-2000 National Hospital Ambulatory Medical Care Survey using logistic regression analyses was conducted. The dependent variable was the modes of arrival (EMS vs. not EMS) to the ED. Independent variables were grouped into four domains: demographic, clinical, system, and service characteristics. Between 1997 and 2000, 38% of EMS responses were for patients aged 65 years and older. During that period, 62.2 million older adult ED patient visits occurred; 38% arrived via EMS. The average rate of EMS utilization by older adults was 167/1,000 population per year, more than four times the rate for younger patients (39/1,000 population). Fifty-three percent of EMS responses with transport to an ED for older adults resulted in hospital admission. Factors found to be associated with EMS mode of arrival included demographic (older age and urban residence), clinical (need for more rapid care and circulatory system illnesses), and service (need for procedures). Older adults account for a large proportion of EMS responses and use EMS at a disproportionately high rate. As the older adult population grows, EMS systems must prepare for the increased volume of older adults by making changes in training, operations, and equipment.
    Academic Emergency Medicine 06/2007; 14(5):441-7. DOI:10.1197/j.aem.2007.01.019 · 2.01 Impact Factor
Show more

Similar Publications