Inappropriate use of the ambulance service.

To determine the rate of inappropriate use of the ambulance service a prospective study of patients brought to a Dublin accident and emergency (A&E) department by ambulance was performed over a 78-day period--358 cases were analysed representing 37% of the ambulance case load. The receiving A&E physician deemed 43.3% of cases to have a definite indication for calling an ambulance, 36.9% a relative indication and 19.8% to have no indication. A strong correlation was shown between a definite indication for transport by ambulance and admission to hospital. Acute medical illness was the most common presentation in the study group (45.8%). Patients themselves were predominant in calling for a 999 ambulance and 35.8% were deemed to have no indication for doing so. When a general practitioner requests the ambulance only 7.4% of cases had no indication for the action. Approximately one-third (31%) of 999 calls were made because the patient had no transport alternative. The problem of ambulance misuse is multifactorial and a variety of strategies are required to address the issue.

The homeless in the emergency department: a patient profile.

OBJECTIVE: To explore the possibility that homeless people use the accident and emergency (A&E) department as a substitute for primary care and to quantify the role of alcohol abuse in their attendances. METHODS: The study period lasted six months. Attendances of all patients registering with "No fixed abode" as their address were analysed from the A&E notes. Information gathered included details of the presenting complaint, general practitioner (GP) registration, and alcohol involvement in the presentation. RESULTS: 135 homeless patients attended the department 233 times; 91% of patients were male with an average age of 40 years; 46% of attendances were during office hours; 81.5% of presentations were for minor problems; 65.2% of patients had co-existing medical problems, with 14.8% having a chronic alcohol problem; 23.7% of patients gave details of their GP and the remainder were either not registered or did not know their GP registration status; 29.6% of attendances directly involved alcohol and another 10.3% were requests for inpatient or outpatient alcohol detoxification; 42.1% of patients questioned said they were aware of the medical facilities available to homeless people in the community; 52.6% of those questioned said they preferred being seen in the A&E department when ill, with 23.7% preferring GP treatment and 10.5% attending community homeless clinics. CONCLUSIONS: The local homeless population may be using the A&E department as a substitute for primary care even in the presence of homeless healthcare facilities in the community. Heightened awareness of these facilities may improve their uptake. Alcohol plays a large role in homeless people seeking medical help in the A&E department. More accessible community facilities for dealing with this problem in this patient group are needed.