Clinical pathway of the critically ill patient in Oulu University Hospital District.

Thesis event information

Date and time of the thesis defence

Place of the thesis defence

Oulu University Hospital,  lecture hall 2

Topic of the dissertation

Clinical pathway of the critically ill patient in Oulu University Hospital District.

Doctoral candidate

Medical Doctor Mia Aitavaara-Anttila

Faculty and unit

University of Oulu Graduate School, Faculty of Medicine, Research Unit of Translational Medicine

Subject of study



Docent Sanna Hoppu, University of Tampere


Professor Janne Liisanantti, University of Oulu

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The usage of EMS varies according to the income level of residental area and treatment delays with critically ill patients were associated with diagnostic challenges

In Emergency medical services (EMS), missions are increasing and the proportion of missions where there is no need for ambulance transportation (non-transport mission) is large. Also, the emergency department (ED) patients flows have increased. The resources to treat critically ill patient are slim and treatment in time-critical. The objective of EMS is to recognize critically ill patients in need of immediate hospital care and start efficient treatment outside hospital. There is a gap in the literature regarding factors associated with delayed intensive care unit admission (ICU) or operating room admission from the ED and also in the use of EMS according to the income of residential areas.

The study population of the thesis consisted of patients encountered by EMS in Northern Ostrobothnia and patients admitted straight to intensive care unit or operating room from the Oulu University Hospital ED. Studies investigated the use of EMS and the effect of income of the residental area., factors associated with delay to angiography with myocardial infarction (MI) patients encountered by the EMS and factors associated with delayed ED length of stay.

Residents living in lowest income areas had more EMS missions than residents in higher income areas and there were more non-transport missions and more high-frequency users of EMS. Coronary angiography of MI-patients was more likely to be delayed if there were absence of chest pain, dyspnoea as the main symptom, the treatment protocol was not followed, treatment was initiated by General Practitioner (GP) and distance to hospital over 100 km. Delayed ICU admission from the ED was associated with radiological examination, Glasgow Coma Scale score above 9, absence of pre-arrival notification and thrombocyte level less than 100 x 109/l. Prolonged ED length of stay prior to emergency operation was associated with first measurement of vital parametres, time to first examination by physician and gastrointestinal diagnosis.

Results of the thesis can be used in developing the treatment pathways of critically ill patient in Northern Finland. This is important as the slim resources of health care should be used the most efficient way.
Last updated: 19.2.2024