What is an acceptable refusal/no transport percentage

[GAmedic1506]

We did an extensive CQI study of 911 patient refusals/no transports back in 2000, and found that when a medic consistently (several months in a row; everyone has a bad month) broke the 36% threshold, they were almost guaranteed a negative patient outcome, regardless of their experience level. I had also heard of a study that was supposedly done by AMR that showed that statistically, for every 100 EMS refusals: 7 patients would be admitted to the hospital, 2 to ICU/CCU, and 1 would die. Has anyone studied this more recently, and if so, what benchmarks do you use ?

[Just Plain Ruff]

wow, that's a really high number.

I'd like to know more. I can't count the number of refusals I've been a part of as a medic but I never had a 36% rate of refusals. That's pretty high in my opinion.

I also don't have a clue how many refusals resulted in a trip or admission to the ER but many of the refusals I can imagine were people who actually didn't want to go by EMS and arrived at the hospital by other means. Are you sure those numbers weren't included in the study as the medic knew that the person was going by private car to the ER. That might have affected the numbers too.

Also not to bash you or criticize you GAMedic as you have brought some interesting points and questions but before you go pointing out statistics it would behoove you to have the study in front of you so you can put the numbers correctly. NOt stating that you're numbers are wrong but just saying you've heard of a study and think these numbers are the right ones I'd have something to back it up, especially on this forum.

[Ace844]

Here are some links to help you with the information you seek.

www.mass.gov/dph/oems/admin/ar_5_610.pdf

http://www.jems.com/educationandtraining/j...agazine/103993/

http://www.jems.com/products/patienthandling/articles/13084/

http://www.aemj.org/cgi/content/abstract/5/11/1080

http://www.ncbi.nlm.nih.gov/entrez/query.f...p;dopt=Abstract

http://www.acgov.org/ems/Resource_policy_m..._guidelines.pdf

http://www.jems.com/columnists/Maggiore/articles/15830/

http://www.aemj.org/cgi/content/abstract/13/5_suppl_1/S48

http://www.aemj.org/cgi/content/abstract/11/7/790

http://www.uhmc.sunysb.edu/emed/paramedic/.../1995/1189.html

http://www.ncbi.nlm.nih.gov/entrez/query.f...p;dopt=Abstract

http://taylorandfrancis.metapress.com/(h22...ults,1:112492,1

https://secure.glatfelters.com/vfis/vfissho...ientreflist.pdf

The services where i work haven't studied this and they use the guidelines provided by the legal and state OEMs communities. Appropriate use of those would virtually eliminate the issue of which you mention.

Hope this helps,

ACE844

[GAmedic1506]

Our survey didnt get into whether or not the medic talked them out of going, or whether it was an actual refusal -- some systems have a "not-needed category" for things such as minor cuts. We only looked at whether or not they were transported, regardless of reason. If they didnt go, they were catagorized as not-transported/refusal (unless it was a false call or we were cancelled enroute). That was kind of the reason for the study, as we frequently had a patient complaint, where the patient stated "they told me i could go to the doctor in the morning", and a patient care report that indicated the medic begged and pleaded for them to go to the ER, but the patient absolutely refused AMA. Many 911 systems have non-transport rates >50% (usually urban).

Thanks for the links, that should help a bunch.

[Just Plain Ruff]

50% are you sure. That sounds like a pretty big number.

I suspect that some of those services with a 50% non transfer rate pass those patients off to a 3rd service. I think 50% is pretty high though. Which services have that 50% rate?

[GAmedic1506]

Well i dont want to name names and embarass folks, but it is not uncommon to approach that stat in the larger american cities. I agree, that is a high number, but urban areas of a higher level of ems abuse. None-the-less, maybe some other services will share their percentages ?

[paramedicmike]

Well i dont want to name names and embarass folks, but it is not uncommon to approach that stat in the larger american cities. I agree, that is a high number, but urban areas of a higher level of ems abuse. None-the-less, maybe some other services will share their percentages ?

Prove it. Stop talking out your...well..if you're going to cite numbers you need proof that you can place out in front of everyone for review.

As far as a 36% refusal rate...if you have a medic who has that high a refusal rate of a one month period then management had damned well better be looking into why this person has such a high rate. Could just be the nature of the calls that month. Could be the number of calls during that months. Could be, and what would worry me most, a lazy medic who just doesn't want to transport a patient.

Once more GA, your fingers are flying over that keyboard but you're not saying anything. Either back up what you're saying with something we all can reference or stop stirring the pot.

[Just Plain Ruff]

GA not to begin to bash you more but you can't state figures and then refuse to say who the services are because you don't want to embarass them. You have seen here that we want hard firm facts and not innuendos and don't want to hurt feelings.

Give us examples of who has 50% refusal rates. They know who they are.

I've worked at 15 different services and none of them had 50% refusal rates. I've worked from a town of 1100 people to three services with excess of 60K calls per year. None of them had 50% refusal rates.

EMS Abuse and such is not a valid argument.

[GAmedic1506]

I am sorry, I will not slam another service by name, especially behind their back, in a forum. That is just immature. If you are not aware of services who have a percentage this high, you must be new to the business, work for a private service, or work in the rural west. You are also obviously a democrat, in that you can not argue anything of substance, but rather find a way to slam others so that you can run from the issue. If you do not like my posts, then simply ignore them. Last time I checked, you are not mandated to respond to any post. And so far, neither of you "fact lovers" have introduced your own stats, which was what I originally asked for. As usual, when you have nothing to contribute, you attack the author like a juvenile. I discussed my stats, which is all i will discuss, and that is all i will ask you to discuss. Man, I cant believe you got me to sink to your level -- i guess i will have to learn how to type nah-nanny-boo-boo.

[Ace844]

I am sorry, I will not slam another service by name, especially when it is not applicable to the conversation. If you are not aware of services who have a percentage this high, you must be new to the business, work for a private service, or work in the rural west. You are also obviously a democrat, in that you can not argue anything of substance, but rather find a way to slam others so that you can run from the issue. If you do not like my posts, then simply ignore them. Last time I checked, you are not mandated to respond to any post.

[marq=up:6951ddddab]EXCUSE YOU..... YOUR ATTACK ON "RUFF," or "PARAMEDICMIKE," IS UNWARRANTED AND UNNECESSARY!! RE-READ HIS POST AND BACK UP YOUR ANSWER WITH FACTS, NOT ATTACKS!!! Stop trying to flame people[/marq:6951ddddab]

ACE844

[stream:6951ddddab]http://koti.mbnet.fi/badbee/wavs/idiotic.wav[/stream:6951ddddab]