Studies demonstrate over-utilization of re-hospital emergency care

When people call for an ambulance, the personnel are expected to make a reasonable assessment of need within a few seconds. These assessments sometimes overestimate and sometimes underestimate the acute medical needs. Lena Marie Beillon in her thesis "To assess medical needs - a clinical dilemma" at the Nordic School of Public Health clearly demonstrates over-utilization of re-hospital emergency care.

In about half of the cases the needs assessments are not optimal. A fraction of the cases are not allocated emergency ambulance care when needed, and a similar fraction receives ambulance care without strict medical reasons. In order to make pre-hospital care more efficient there is a need for improved methods for needs assessment.

In addition, persons with acute needs sometimes were not allocated an ambulance when subsequent medical assessment indicated the need. Underestimation of needs may cause serious risks, while overestimation leads to inappropriate and wasteful use of limited resources, which may not be available when needed.

The aim of setting priorities in health care is to use recourses effectively. Inappropriate needs assessment may lead to under utilization of the competence and capacity available in the pre-hospital care, while over-utilization leads to wasteful use of limited recourses.

These studies were carried out in cooperation with the organisations for pre-hospital care in West Sweden, in the County of Norrbotten and in Southern Finland. Results indicate that over- as well as under-utilization are common in all geographical areas, however, over- utilization seems to be most frequent in the large cities. A common notion among lay persons is that ambulance transports are most frequent in connection with accidents. However, in Lena Marie Beillons studies only one out of ten transports was made for accidents. The most common causes of need for an ambulance were associated with breast pain and fear of acute heart disease.

Important findings from the studies were the over-utilization of ambulance transports for persons without strict medical needs and for planned transports between providers i.e. hospitals and nursing homes. For such transports the capacity and competence in the pre hospital organisation are not needed and wasted. One conclusion from the studies with impact on the structure of health care, is that there is a need for alternatives for transporting persons with special medical needs, but not with need for an ambulance.

The Health Care Act includes decrees on medical priorities. These rules are based on the principle of medical needs. Lena Marie Beillon´s thesis indicates, that this goal is difficult to reach in ambulance care.