This study shows that the out-of-hours doctors interviewed responded with a call-out in two out of three of the emergency situations they were alerted about. Factors concerning the patient’s condition were the most common reason for the doctor choosing to respond with a call-out. On completion of the call-out the participation was regarded as necessary in two-thirds of the incidents, primarily due to the need for medical expertise. Among those who turned out but who afterwards did not view the call-out as necessary, this was most often related to the patient’s condition. The most important reasons for not responding with a call-out were practical aspects associated with travelling time, time constraints and the like.
The red response rate in this study was 15 alarm calls per 1,000 inhabitants per year, i.e. somewhat lower than the rate identified in other Norwegian studies which is 20 – 31 per 1,000 per year (9, 10). The calculation assumes that the proportion of alarm calls is the same throughout the 24 hours and the whole week. Previous studies have found that a few more incidents occur during the day and at weekends, so that our calculated rate is most likely an underestimate (9, 10).
Incidents that occurred during the day and at weekends are not included in the study. A total of 72 interviews were conducted for 252 relevant alarm calls. Among the doctors invited to participate, 49 % were interviewed. This, plus the fact that some doctors were interviewed several times, may have distorted the results. A frequent reason for the doctor not being interviewed was a lack of contact information, but it is presumably incidental which alarm calls this applied to. In this study the rate of responding with a call-out was 65 % higher than that found in two other studies (4, 6). In contrast to the two other studies, this study investigated rural municipalities where call-outs are traditionally more frequent compared with urban municipalities. Nonetheless we cannot exclude the possibility that doctors who responded with a call-out were more willing to be interviewed, which may cause a distortion of the results. We are of the view that the study makes a major contribution to knowledge about call-outs from out-of-hours primary health care, even though some of the findings are uncertain and cannot necessarily be transferred to all local authorities.
There was a non-significant tendency for doctors with little experience to respond with a call-out more often and to assess the call-out as unnecessary afterwards compared with doctors with more experience. This may be because doctors with little experience are not as good at assessing the information in the initial notification, or that they nonetheless decide to turn out to gain experience. It could also be the case that doctors with less experience are not as willing to be interviewed about the times they have not responded with a call-out.
When the doctor deemed it necessary to have been present, the most common reason was clearly that she/he contributed significant medical expertise. However, we cannot rule out the possibility that the ambulance staff would have been of the view that they could have handled the situation themselves. A previous study showed that ambulance staff for the most part handle diagnostic and treatment challenges, and mainly contact the out-of-hours doctor when it is a question of whether or not the patient can stay at home (6). At the same time the doctor’s presence is still important in situations where there is no standardised pre-hospital treatment procedure or where there are more complicated differential diagnostic challenges (12).
When the doctors afterwards regarded their presence as unnecessary, the most common reason was that the patient was less injured than presumed or that her condition had stabilised. It can be debated whether there are grounds to assess the doctor’s presence as unnecessary. It is not possible beforehand to predict how a situation will develop, and if a doctor waits, then it may be too late (13). Several of the doctors in our study justified their presence by the fact that they could calm down the situation. Another doctor may perhaps have assessed the same call-out as unnecessary.
The initial notification from the EMCC presumably has considerable importance for the doctor’s decision on whether or not to respond with a call-out. The quality of the notification is therefore vital, and efforts should be made to ensure that it is of good quality and contains sufficient and relevant information to provide the doctor with an appropriate platform to make a decision on a possible call-out. However, this decision is based on an overall assessment of the patient’s condition, on what is practically possible for the doctor and on what is best for the patient and the doctor’s other patients.