Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Prehosp Emerg Care. 2010 Apr-Jun;14(2):245-9. doi: 10.3109/10903120903537197.
Patients belonging to a managed care organization (MCO) who call 9-1-1 are typically transported to their MCO facility only if it is also the closest emergency department (ED). As past medical records and close follow-up are unavailable at the non-MCO facility, unnecessary workups and/or admissions may result.
To examine the safety and feasibility of preferentially transporting MCO patients to the closest MCO ED rather than the closest ED.
This was a retrospective review over a 52-month period comparing all patients transported by ambulance to an MCO ED when that destination was not the closest ED (targeted group) with all other transported patients. If the MCO facility was not the closest ED, then the emergency medical services (EMS) provider would be reimbursed an additional fee beyond the routine ambulance charges. The primary outcome measure was the additional ambulance transport time. The secondary outcome measure was mortality within the first 24 hours.
There were 15,938 patients transported under this program from July 2000 through December 2004 for whom outcome data were available. Of these, 10,532 (66%) were transported by advanced life support (ALS) ambulance. The mean (+/- standard deviation) transport time to the hospital for all targeted patients transported during the study interval was 10.4 minutes (+/-3.2 minutes) compared with 8.6 minutes (+/-2.1 minutes) for all transported patients (p < 0.001). No patient required ventilatory support in the field. Twelve (0.1%) patients died during the subsequent hospital admission and, after a blinded chart review, none of the deaths were deemed to be preventable or likely to have resulted from additional transport time.
Our study suggests that paramedic transport of MCO patients to the nearest MCO hospital in lieu of the nearest ED is safe and feasible. Given the potential benefits to patient care, this program should be evaluated in other EMS systems.
属于管理式医疗组织（MCO）的患者拨打 9-1-1 后通常只会被送往与其 MCO 设施最近的紧急部门（ED）。由于在非 MCO 设施无法获取过往病历和密切随访信息，可能会导致不必要的检查和/或住院治疗。
研究优先将 MCO 患者送往最近的 MCO ED 而非最近的 ED 的安全性和可行性。
这是一项回顾性研究，比较了在 52 个月期间所有通过救护车送往 MCO ED（目标人群）的患者与所有送往其他医院的患者。如果 MCO 设施不是最近的 ED，那么 EMS 提供者将获得超出常规救护车收费的额外费用。主要结果衡量标准是额外的救护车运输时间。次要结果衡量标准是 24 小时内的死亡率。
2000 年 7 月至 2004 年 12 月期间，根据该计划共转运了 15938 名患者，其中有 10532 名（66%）是通过高级生命支持（ALS）救护车转运的。在研究期间转运的所有目标患者的平均（+/-标准差）到达医院的运输时间为 10.4 分钟（+/-3.2 分钟），而所有转运患者的平均（+/-标准差）到达医院的运输时间为 8.6 分钟（+/-2.1 分钟）（p < 0.001）。没有患者在现场需要通气支持。在随后的住院期间有 12 名（0.1%）患者死亡，在经过盲法图表审查后，没有死亡被认为是可以预防的，也不太可能是由于额外的运输时间造成的。
我们的研究表明，将 MCO 患者由护理人员送往最近的 MCO 医院而不是最近的 ED 是安全可行的。鉴于对患者护理的潜在好处，应该在其他 EMS 系统中评估该计划。
