Refusal of Transport
Conditions
Keywords
EMS transport, emergency treatment, EMS protocol
Brief summary
The primary goal of this study is to find out if patients who speak with an EMS physician over the phone are less likely to refuse care compare to patients who do not speak with an EMS physician.
Detailed description
This study aims to assess the impact of direct physician communication on patients' decisions to refuse EMS transport. The research approach is designed to measure the influence of physician interaction on patient transport decisions in a prospective model. By conducting this research, the study team hopes to provide evidence-based recommendations for EMS protocols regarding patient engagement and refusal management.
Interventions
BEHAVIORALPhysician Consultation
Every other month will be randomized to either Physician Consultation or Standard of Care. During the months designated for Physician Consultation, direct communication between the patient and a designated physician by phone will be implemented when a patient refuses transport in cases where the EMS clinician feels that physician consultation is warranted for further guidance. The physician will attempt to address patient concerns and provide additional medical advice.
BEHAVIORALStandard of Care
Every other month will be randomized to either Physician Consultation or Standard of Care. During the months designated for Standard of Care, physician intervention will not be provided. For safety reasons, if physicians or EMS MEDIC clinicians feel that speaking with the patient is important to provide additional clinical benefit, they may do so without hesitation and can override the designated intervention month.
Sponsors
Wake Forest University Health Sciences
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
• Adult patients ≥18 years old in care of Mecklenburg EMS (MEDIC) on an emergency basis (911 call) who wish to refuse transportation to the hospital in whom MEDIC has, via existing processes and decision-making, engaged online medical control EMS Physicians for further guidance
Exclusion criteria
* Patients \<18 years old. * Patient refuses to speak with online medical control EMS Physicians. MEDIC or patient requests to have primary care physician. * Lack of clinical capacity. * Incarcerated population.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Patients Transported | Day 1 | Number of patients who agreed to be transported by EMS |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Patients Admitted to Hospital | Day 1 | Number of patients admitted to hospital after being transported by EMS |
| Number of Patients Discharged from Emergency Department | Day 1 | Number of patients discharged from Emergency Department after being transported by EMS |
| Duration of EMS Interaction | Day 1 | Length of time from EMS arrival to the end of the patient interaction in minutes and seconds |
| Number of EMS Same-Day Return | Hour 24 Post Initial Call | Number of times EMS is called again to attend to a patient who earlier refused transport |
Countries
United States
Contacts
CONTACTStephen Tyler Constantine
PRINCIPAL_INVESTIGATORStephen Tyler Constantine, MD
Atrium Health Carolinas Medical Center
Outcome results
None listed