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 and Guillaume Alinier
Additional contact information
Hassan Farhat: Ambulance Service, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
Cyrine Abid: Faculty of Medicine, University of Sfax, Sfax P.O. Box 3000, Tunisia
Kawther El Aifa: Ambulance Service, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
Padarath Gangaram: Ambulance Service, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
Andre Jones: Ambulance Service, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
Mohamed Chaker Khenissi: Ambulance Service, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
Moncef Khadhraoui: Higher Institute of Biotechnology, University of Sfax, Sfax P.O. Box 3038, Tunisia
Imed Gargouri: Faculty of Medicine, University of Sfax, Sfax P.O. Box 3000, Tunisia
Loua Al-Shaikh: Ambulance Service, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
James Laughton: Faculty of Health Sciences, Durban University of Technology, P.O. Box 1334, Durban 4000, South Africa
Guillaume Alinier: Ambulance Service, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar

IJERPH, 2023, vol. 20, issue 14, 1-20

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: non-conveyance; emergency medical services; paramedics; Middle East; pre-hospital environment (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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