J. Alicandro et al., IMPACT OF INTERVENTIONS FOR PATIENTS REFUSING EMERGENCY MEDICAL-SERVICES TRANSPORT, Academic emergency medicine, 2(6), 1995, pp. 480-485
Objective: To evaluate the effect of a documentation checklist and on-
fine medical control contact on ambulance transport of out-of-hospital
patients refusing medical assistance. Methods: Consecutive patients s
erved by four suburban ambulance services who initially refused emerge
ncy medical services (EMS) transport to the hospital were prospectivel
y enrolled. In phase 1 (control phase), all patients who initially ref
used medical attention or transport had an identifying data card compl
eted. In phase 2 (documentation phase), out-of-hospital providers comp
leted a similar data card that contained a checklist of high-risk crit
eria for a poor outcome if not transported. In phase 3 (intervention p
hase), a data card similar to that used in phase 2 was completed, and
on-line medical control was contacted for all patients with high-risk
criteria who refused transport. The primary endpoint was the percentag
e of patients transported to the hospital. Results: A total of 361 pat
ients were enrolled. Transport rate varied by phase: control, 17 of 14
4 (12%); documentation, 11 of 150 (7%); and intervention, 12 of 67 (18
%) (chi-square, p = 0.023). Transport of high-risk patients improved w
ith each intervention: control, two of 60 (3%); documentation, seven o
f 70 (10%); and intervention, 12 of 34 (35%) (chi-square, p = 0.00003)
. Transport of patients without high-risk criteria decreased with each
intervention: control, 15 of 84 (18%); documentation, four of 80 (5%)
; and intervention, 0 of 33 (0%) (p = 0.0025). Of the 28 patients for
whom medical control was contacted, 12 (43%) were transported to the h
ospital, and only three of these 12 patients (25%) were released from
the ED. Conclusion: Contact with on-line medical control increased the
likelihood of transport of high-risk patients who initially refused m
edical assistance. The appropriateness of the decreased transport rate
of patients nor meeting high-risk criteria needs further evaluation.