Patient and physician perspectives on ambulance utilization

Objective. The objective of the current study was to define the clinical and demographic characteristics of ED patients who used ambulance transport (USERS) compared to contemporaneous non-ambulance users (NON) and to 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, and self-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) and were 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), and admission rate (37% vs. 15%, p < 0.0001). Patient decision regarding ambulance use was associated with both having someone who called an ambulance for them and self-estimation of illness severity (or lack thereof). Physicians agreed with transport method in 68% of USERS and 92% 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 and two-thirds of the time agreed that a patient's decision to use ambulance transport was appropriate.