Beyond the Gatekeeper: Navigating Safety and Equity in Ambulance Self-Care Referrals [B057] Har passerat
Torsdag 7 maj 2026 09:00 - 13:30 Poster Arena
Rapportör: Cecilia FagerSpår: Poster session, Healthcare Organization
Background Ambulance clinicians increasingly refer patients to self-care, positioning the ambulance service within a complex gatekeeping role. Clinicians must assess whether self-care is a safe option or if further support is needed. Unlike referrals to primary healthcare centers (PHCs), structured follow-up after self-care referrals is often lacking, and the consequences of these decisions remain largely unexplored. This study investigates outcomes and predictors of subsequent healthcare contact and mortality among patients referred to self-care by ambulance services in three Swedish regions. Methods We conducted a retrospective cohort study of 6,496 ambulance assignments in 2023 that resulted in self-care referrals (970 children, 5,526 adults). The primary outcome was subsequent healthcare contact (including recontact, PHC visits, new ambulance calls, emergency department visits, and hospitalizations) and all-cause mortality within 72 hours and 30 days. Bayesian multilevel logistic regression models were used to estimate the probability of recontact and mortality. Results Of the 6,496 self-care referrals, 30% resulted in subsequent healthcare contact (adults: 29,2%; children: 23,7%), most commonly to PHCs (adults: 55,8%; children: 60,3%). Observed mortality was 0,9% within 72 hours and 2,9% within 30 days (adults: 0,9%, 2,9%; children: 0%). Among children, respiratory, infectious, and general medical symptoms were most common; among adults medical, surgical, and neurological symptoms dominated. Predictors of recontact included older age, longer on-scene time, use of Advisory decision support system (ADSS), and distance to hospital. The strongest predictor was the type of complaint, with orthopedic cases showing the highest recontact rates. Conclusion Nearly one-third (30%) of patients sought additional care within 72 hours of a self-care referral. While this does not necessarily indicate negative outcomes, the lack information follow-up and patient-reported data limits interpretation. Future research should explore patients’ perspectives to better understand re-attendance and improve the safety of self-care referrals.
Konferens
GCPCC
GCPCC Kod
PCC270
Föreläsare
Cecilia Fager Rapportör
PhD
Region Kalmar län/Linnéuniversitetet
Presentation of PhD Project
Poster Title: Beyond the Gatekeeper: Navigating Safety and Equity in Ambulance Self-Care Referrals
Background
In current practice, an increasing number of patients are referred to self-care by the ambulance service instead of being transported to a hospital. However, the concept of "self-care" is unclearly defined. There is currently a lack of scientific studies regarding whether these referrals are performed in a patient-safe manner and how they are experienced by patients, relatives, and ambulance clinicians. Previous research highlights that the referral process is complex and time-consuming, requiring a high level of competence from ambulance clinicians. Furthermore, there is a demand for adequate assessment and decision-support tools to minimize potentially incorrect decisions and ensure patient safety.
The Doctoral Project
This project aims to contribute vital scientific knowledge to support the quality assurance of self-care referrals. It places significant emphasis on acknowledging the perspectives of patients and their relatives to gain knowledge of expectations and needs—areas that currently represent a knowledge gap. The project includes both interview studies and a medical record review study focusing on the follow-up of patients referred to self-care.
The poster presented today, Beyond the Gatekeeper: Navigating Safety and Equity in Ambulance Self-Care Referrals, represents one of the sub-studies within this doctoral project.
Expected Contribution
Collectively, the project will contribute new knowledge regarding the relevance of specific decision-support systems within the context of the ambulance service, as well as the ability to identify risks that may arise in connection with referrals to self-care.