title: Patient and physician perspectives on ambulance utilization.
abstract: 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.
authors: St. Luke's Hospital, Emergency Medicine Residency, Bethlehem, Pennsylvania 18015, USA. jacobs@slhn.org
authors: Sharon L
authors: SL
authors: Jacob
authors: Jeanne
authors: J
authors: Jacoby
authors: Michael
authors: M
authors: Heller
authors: Jill
authors: J
authors: Stoltzfus
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000552:Ambulances / Q000706:statistics & numerical data*; D002755:Choice Behavior; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010361:Patients / Q000523:psychology*; D010414:Pennsylvania; D010820:Physicians / Q000523:psychology*