Online medical control and initial refusal of care: does it help to talk with the patient?
The use of online medical control (OLMC) for initial refusal of care is time-consuming and has medical-legal risks.


OBJECTIVE
This study attempted to answer the following: Does physician-patient communication (PPC) increase the rate of transport and at what cost in terms of increased physician time? Do altered mental status (AMS) patients agree to transport more frequently and do they require more physician time? Can senior emergency medicine resident (RES) and emergency medicine faculty (FAC) physicians be equally efficient in handling refusal calls?


METHODS
The study evaluated a retrospective cohort for six months at a single base station, university hospital. Online medical control audiotapes and written records of radio and telephone communications were reviewed.


RESULTS
One hundred forty-seven refusal cases were analyzed, PPC was used 70 times, and 37 patients were transported. Twenty-four of 70 (34%) patients with PPC agreed to be transported, while ten of 77 (13%) patients without PPC agreed to be transported (p = 0.002). Sixteen of 30 (53%) patients with AMS were transported compared with 21 of 117 (18%) patients with normal mental status (p = 0.00007). Call times were longer with PPC utilization [406.3 sec PPC vs 230.1 sec no PPC (p < 0.001)] and with AMS patients [411.2 sec AMS vs 289.1 sec no AMS (p = 0.028)]. The RES and FAC physicians did not differ in transport rates [21% RES vs 26% FAC (p = 0.612)] and call times [329.4 sec RES vs 310.4 sec FAC (p = 0.659)].


CONCLUSIONS
Although time-consuming, the use of PPC is associated with more patients' agreeing to be transported. Patients with AMS are transported more frequently and they use more physician time. Emergency medicine RES and FAC physicians have equal efficiency and efficacy in handling these calls.
Hoyt
B T
BT
Department of Emergency Medicine, Oregon Health Sciences University, Portland, OR 97201-3098, USA. hoytb@ohsu.edu
Norton
R L
RL
D000435:Alcoholic Intoxication / Q000523:psychology*; D015331:Cohort Studies; D003142:Communication; D003221:Confusion / Q000523:psychology*; D004631:Emergency Medical Service Communication Systems / Q000458:organization & administration*; D004638:Emergency Treatment / Q000379:methods* / Q000523:psychology*; D005180:Faculty, Medical / Q000458:organization & administration; D006801:Humans; D008505:Medical Staff, Hospital / Q000458:organization & administration* / Q000523:psychology*; D016743:Mental Competency; D008875:Middle Aged; D009862:Online Systems / Q000458:organization & administration*; D009922:Oregon; D010353:Patient Education as Topic / Q000458:organization & administration; D010819:Physician's Role; D010817:Physician-Patient Relations; D012189:Retrospective Studies; D013997:Time Factors; D014187:Transportation of Patients / Q000706:statistics & numerical data*; D016312:Treatment Refusal / Q000523:psychology*; D016526:Workload