What is an acceptable refusal/no transport percentage

[Just Plain Ruff]

GA here is what I'm gonna do. I'm gonna call my friends at the following services and ask them what their refusal rates are. I will post these numbers but I will not post their names as sometimes services do not want this information going out.

I will call

NYHQ emergency services (New York HOspital Queens, Queens New York)

Patterson New Jersey EMS

I will personally go over to the nearest fire department station here in miami and talk to someone on the on duty medic truck

Detroit Michigan

Baltimore, MD

Colorado Springs, Colorado (AMR)

Seattle Washington

and LAFD

and several others.

I'll try to have those figures tomorrow. These are friends of mine so I won't mention what their names are but the services are some of the busiest in the country.

What my expectation is of you is that you provide the service names , no contact info in the list, and tell us what services in the country have upwards of 50% no transport.

What I think the group also wants to know is what is your services rate of no transports? is it in the 50% range?

I see you've been notoriously absent from this post the past while or so so I wonder if you really don't have the figures to prove the points you were making.

[Ace844]

To everyone, I apologize for my previous comments, as that was very immature. As far as the need to talk about other agencies behind their back, that is just something I will not do. If they wish to divulge or discuss their numbers, they will when they read this post. It is not my place to fix any service but my own, nor is it my place to "dog" a service that is struggeling. If there is anyone out there that does not believe there are 911 services with no transport rates near 50%, then my naming of them will not convince you. But I can assure you that there are services in GA and Florida with rates that high.

I will answer anything about my own service, though. My service is a 911 provider near but not in Atlanta. We average a 28-32% refusal rate, depending upon the month of the year. To reduce the liability in said refusals, we created pre-printed home-care instructions (illness/injury specific) that we leave with the patient. The purpose of my question was to learn what others are doing, not to call-out or punish those who do not meet my or your standard. If my failure to talk about others behind their back loses me points with you, then so be it. Either way, it is time for this to get back on the professional level.

Actually it seems to me that leaving 'Point of care' and FINAL DIAGNOSIS-INJURY CARE 'follow up instructions,' would require the individual EMS provider to have made a FINAL diagnosis, than accepted a pt refusal; which would put you and your service in an unteneable legal position in many 'areas'. Seems to me we do diagnosis, but it is a working diagnosis, not a final one, and furthermore, you would need to assess and treat a pt to get a FINAL DIAGNOSIS which i am sure your Med con and many others would disapprove of ..

Out Here,

ACE844

[Just Plain Ruff]

so you leave printed instructions for a specific problem with the patient??? I have a question on that, I believe that that will definately put you in a very precarious legal position as it sounds a lot like you are diagnosing a patients problem. It's my understanding that the only person who can diagnose something is a doctor or NP/PA.

I would be curious to see how your legal department looks at this "diagnosis" that it sounds like you are doing. I'm just trying to get a clear picture of what exactly you put on the documentation you leave with the patient. It seems a little like diagnosing. Of course I could be wrong.

Let me ask you one more question.

The no transport rate - is that number include calls that you got called out on but got cancelled on or is this number only refusals? I'm curious.

The only problem I have with your apology is that you still quoted the high percentage rate yet refuse to cite services that have that rate. In my opinion it makes your original premise of the post null and void but that is just my opinion.

Next time you begin a personal attack please re-read and think about what you are posting. I never delved into personal attacks on you yet you did to me and that my friend is unprofessional.

[GAmedic1506]

No, its not like that -- it is symptom based. For instance for Chest Pain it goes over the symptoms for AMI again, clarifying that they understand that they are possibly having an MI. For minor lacs, it explains that they need sutures within 6-hours. For N&V, it goes over the bland diet, for hypoglycemia it discusses that they should eat, should recheck their glucose often, and gives them their pre &post EMS treatment readings, so they can inform their physician, and how to care for their IV site/wound. All of them educate the patient to what their symptoms could indicate. It doesnt tell them what their diagnosis is. If I remember right we have one for Chest Pain, Fever, Head Injury, SPrain/Strain, Domestic Abuse, Dyspnea, MVC, Woudcare, Diabetes, Seizure, Address Hard To Find, I cant remember the rest. JEMS gave us a thumbs up on the back page of either the 12/2000 or 12/2001 issue (the cover story is Aussie Motorcycle Medics), and listed a complete copy of the instructions on their webpage (not sure if they are still on there)

[Ace844]

No, its not like that -- it is symptom based. For instance for Chest Pain it goes over the symptoms for AMI again, clarifying that they understand that they are possibly having an MI. For minor lacs, it explains that they need sutures within 6-hours. For N&V, it goes over the bland diet, for hypoglycemia it discusses that they should eat, should recheck their glucose often, and gives them their pre &post EMS treatment readings, so they can inform their physician, and how to care for their IV site/wound. All of them educate the patient to what their symptoms could indicate. It doesnt tell them what their diagnosis is.

[Just Plain Ruff]

GA thanks for the clarification.

[GAmedic1506]

your welcome --so does anyone else's organizations do anything different in this area ?

[Just Plain Ruff]

I can't say for the group here but in the state of missouri the state has put out a refusal form that fits the missouri guidelines.

As for services I've worked for, we give a call 911 back if needed form and document the risks of refusal and in the other box I always put "Death" as a consequence of refusal. It works a lot of times.

[whit72]

I don't believe there is an acceptable refusal percentage, it should be on a case by case basis. They should be audited by your Q/A dept.

I can say that I have never discouraged one pt from being transported to the hospital. If they want to go they go. This might have to do with the fact that we have to fill out the SARF whether we transport or not.

Being so close to the hospital its easier to transport then sit their in argue with them. If we cmed a stable pt with a complaint that can be fast tracked, when we arrive a nurse eyeballs them and they go to chairs. Its maybe 30 minutes from when my feet hit the floor till my head is back on the pillow. No sweat.

Its not my job to educate the public of the proper use of the 911 system. especially at 3 in the morning......LOL

[GAmedic1506]

I am with you on that one. At the busiest service that I worked at, we knew that we could either transport 8-10 or not transport 14-20, you had to do the same amount of paperwork whether you took them or not. If the AMR model is right and you only kill 1 out of every 100 that refuse (1%), that number can sound reasonable. But if you are running 50,000 calls a year, that equates to 500 patient deaths. So if you are ever looking for a good CQI project for your service, I would point you in this direction, and ask: How do you know that your employees educated the patient properly, and did all that they could to get an AMA patient to go to the hospital ? Is what the patient is being told consistent, by all crews, and at all times of the day or night ? What is your refusal percentage after midnight (yes the call acuity is generally lower after midnight, but the medics can also be tired and sleepy) ?