Emergency Call versus General Practitioner Requested Ambulances - Patient Mortality, Disease Severity and Pattern

Morten Breinholt Søvsø; Rasmine Birch Haurum; Trine Hagelskær Ebbesen; Ann Øster Rasmussen; Logan Morgan Ward; Mads Lause Mogensen; Erika Frischknecht Christensen; Tim Alex Lindskou

doi:10.2147/CLEP.S469430

Emergency Call versus General Practitioner Requested Ambulances - Patient Mortality, Disease Severity and Pattern

Clin Epidemiol. 2024 Jul 30:16:513-523. doi: 10.2147/CLEP.S469430. eCollection 2024.

Authors

Morten Breinholt Søvsø¹, Rasmine Birch Haurum², Trine Hagelskær Ebbesen², Ann Øster Rasmussen², Logan Morgan Ward³, Mads Lause Mogensen³, Erika Frischknecht Christensen¹, Tim Alex Lindskou¹

Affiliations

¹ Centre for Prehospital and Emergency Research at Danish Centre for Health Services Research; Aalborg University Hospital and Department of Clinical Medicine, Aalborg University, Gistrup, Denmark.
² Department of Health, Science and Technology, Aalborg University, Gistrup, Denmark.
³ Treat Systems ApS, Aalborg, Denmark.

Abstract

Introduction: Ambulance requests by general practitioners for primary care patients (GP-requested) are often omitted in studies on increased demand within emergency care but may comprise a substantial patient group. We aimed to assess acute severity, intensive care unit (ICU) admission, and diagnostic pattern, including comorbidity, and mortality among GP-requested ambulance patients, compared to emergency call ambulance patients. Our hypothesis was that emergency call patients had more severe health issues than GP-requested ambulance patients.

Methods: Historic population-based cohort study of ambulance patients in the North Denmark Region, 2016-2020. Hospital contact data including diagnoses, ambulance data, vital signs and vital status was linked using each patient's unique identification number. Primary outcome measure was mortality within 1, 7, and 30 days. Secondary outcomes were disease severity expressed as modified National Early Warning Score (NEWS2), and ICU admission. Admission status and hospital diagnostic pattern, including comorbidity were described and compared.

Results: We included 255,487 patients. GP-requested patients (N = 119,361, 46.7%) were older (median years [IQR] 73 [58-83] versus 61 [37-76]) and more had moderate/severe comorbidity (11.9%, N = 13,806 versus 4.9%, N = 6145) than the emergency call patients. Prehospital mNEWS2 median scores were lower for GP-requested patients. For both groups, mNEWS2 was highest among patients aged 66+. GP-requested patients had higher 30-day mortality (9.0% (95% CI: 8.8-9.2), N = 8996) than emergency call patients (5.2% (95% CI: 5.1-5.4), N = 6727). Circulatory (12.0%, 11,695/97,112) and respiratory diseases (11.6%, 11,219/97,112) were more frequent among GP-requested patients than emergency call patients ((10.7%, 12,640/118,102) and (5.8%, 6858/118,102)). The highest number of deaths was found for health issues 'circulatory diseases' in the emergency call group and 'other factors' followed by "respiratory diseases" in the GP-requested group.

Conclusion: GP-requested patients constituted nearly half of the EMS volume, they were older, with more comorbidity, had serious conditions with substantial acute severity, and a higher 30-day mortality than emergency call patients.

Keywords: after-hours care; diagnoses; early warning scores; emergency medical services; general practitioners; mortality; primary healthcare.

Grants and funding

EFC is supported by an unrestricted grant to her professorship from the philanthropic TRYG foundation to Aalborg University. The project has been supported by the European Union’s European Fund for Regional Development through Life-Science Innovation North Denmark’s program “Sundhedsteknologisk Serviceprogram (SSP) [Healthcare Technology Service Program]”. Project ID 036. None of the funding organizations had any influence on the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.