Patient andPhysician Perspectives on Ambulance Utilization

Abstract

Objective. The objective of the current study was to define the clinical anddemographic characteristics of ED patients who used ambulance transport (USERS) compared to contemporaneous non-ambulance users (NON) andto determine the reasons users gave for their choice to use ambulance transport. Methods. A single researcher queried a convenience sample of consenting ED patients regarding reasons for choice of transport to the ED, knowledge of ambulance cost, andself-estimation of illness or injury severity on a (1 most severe, 5 least severe) five-point Likert scale. We also asked if the treating physician agreed with transport choice. Results. Of 311 participants (97% response rate), USERS (N = 71, 22.8%) were older than NON (53 vs. 35, p < 0.0001) andwere more sick according to self-rated illness severity (mean rank 128 vs. 156, p = 0.02), nurse triage score (mean rank 103 vs. 153, p < 0.0001), andadmission rate (37% vs. 15%, p < 0.0001). Patient decision regarding ambulance use was associated with both having someone who called an ambulance for them andself-estimation of illness severity (or lack thereof). Physicians agreed with transport method in 68% of USERS and92% of NON (overall kappa = 0.6, p < 0.0001). Conclusions. Ambulance users were more likely to be more sick as determined by commonly used measures than nonusers. ED physicians almost always agreed with nonuse of ambulance transport andtwo-thirds of the time agreed that a patient's decision to use ambulance transport was appropriate.

Key words:

• ambulance
• transport
• emergency department
• resource use