Follow-up of elderly patients who refuse transport after accessing 9-1-1.
OBJECTIVE
To obtain medical follow-up and determine reasons why elderly patients access paramedics via 9-1-1 and then refuse transport.


METHODS
A telephone survey of patients aged 65 years and older who refused transport and signed out against medical advice (AMA) after accessing paramedics via 9-1-1 was performed to obtain information about the patients' experiences, reasons why they refused, medical follow-up, and patient outcomes.


RESULTS
One hundred of 121 (83%) patients who were contacted by telephone participated in the survey. Patients stated that financial concerns were a major determinant in refusing to be transported. Overall, 70% of the patients reported receiving follow-up medical care. Care was obtained at an emergency department (ED) via a second 9-1-1 call in 16% of cases, at an ED via private vehicle in 13%, at an urgent care clinic by a private vehicle in 35%, and with a family physician via private car in 38% of cases. Of the patients who obtained follow-up, there was a 32% hospital admission rate, with 39% of those admitted to an intensive care unit setting. Finally, 80% of the sample studied did not speak to a physician online, with 49% stating that they would have changed their minds if a physician had suggested transport.


CONCLUSIONS
The majority of patients who were 65 years of age and older and refused transport received follow-up care, with a significant number requiring admission to the hospital at the time of their follow-up.
Vilke
Gary M
GM
Department of Emergency Medicine, University of California, San Diego 92103, USA. gmvilke@ucsd.edu
Sardar
Winfred
W
Fisher
Roger
R
Dunford
James D
JD
Chan
Theodore C
TC
D000368:Aged; D002140:California; D003657:Decision Making; D004631:Emergency Medical Service Communication Systems / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014187:Transportation of Patients / Q000706:statistics & numerical data*; D016312:Treatment Refusal; D014505:Urban Population