Division of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada.
Acad Emerg Med. 2010 Dec;17(12):1383-9. doi: 10.1111/j.1553-2712.2010.00928.x.
ambulance diversion is a dangerous repercussion of emergency department (ED) crowding and can reflect fragmentation and a lack of coordination in designating optimal patient offload sites for prehospital providers. The objective of this study was to evaluate whether proactive destination selection through the Regional Emergency Patient Access and Coordination (REPAC) program would enhance capacity and ED flow management.
the REPAC system provides a dashboard that synthesizes real-time capacity and acuity data for all three adult EDs in the city of Calgary, assigning a color code to reflect receiving status. It assigns destination for the next patient transported by emergency medical services (EMS) by categorizing ED sites as having either a favorable (green/yellow) status or unfavorable (orange/red) status. Three time windows were analyzed: a 6-month window prior to REPAC implementation (pre), the first 6-month window immediately following (post1), and the second 6-month period following (post2). Primary outcomes of interest were the proportion of time spent in favorable versus unfavorable status and EMS avoidances for all adult ED sites in the region (percentage of total time with any center on EMS bypass). Information on total number of ED visits, percentage of patients arriving by EMS transports, admission rates, patient acuity (Canadian Triage and Acuity Score), age, and length of stay (LOS) for admitted and discharged patients was collected. The Kruskal-Wallis test was employed for primary outcome analysis.
implementation of the REPAC system resulted in an increase in the proportion of total time region hospitals reported favorable status (57.5% vs. 64.1%) pre versus post1, an effect that was accentuated at 1 year (post2, 78.7%; p < 0.001 for both comparisons). There was a concomitant decrease in EMS avoidances as a result of the REPAC system, 4.4% to 1.8% (pre vs. post1), also further improved at 1 year to 0.6% (p < 0.001 for both comparisons).
proactive EMS destination selection through a real-time integrated electronic surveillance system enhances regional capacity and flow management while significantly reducing ambulance diversions.
救护车分流是急诊科（ED）拥挤的危险后果，反映了在为院前提供者指定最佳患者下车地点方面的碎片化和协调不足。本研究的目的是评估通过区域急诊患者准入和协调（REPAC）计划主动选择目的地是否会增强能力和 ED 流程管理。
REPAC 系统提供了一个仪表板，汇总了卡尔加里市所有三个成人 ED 的实时容量和 acuity 数据，为反映接收状态的颜色代码。它通过将 ED 站点分类为有利（绿色/黄色）状态或不利（橙色/红色）状态，为通过紧急医疗服务（EMS）运输的下一位患者分配目的地。分析了三个时间窗口：在实施 REPAC 之前的 6 个月（前）、紧随其后的第一个 6 个月（后 1）和第二个 6 个月（后 2）。主要观察指标是在有利和不利状态下花费的时间比例以及该地区所有成人 ED 站点的 EMS 避免率（任何中心使用 EMS 旁路的总时间百分比）。收集了有关 ED 就诊总次数、通过 EMS 转运到达的患者百分比、入院率、患者 acuity（加拿大分诊和 acuity 评分）、年龄和入院和出院患者的停留时间（LOS）的信息。采用 Kruskal-Wallis 检验进行主要结果分析。
REPAC 系统的实施导致报告的区域医院总时间有利状态的比例增加（57.5%比 64.1%，前与后 1 相比），1 年后效果更为明显（后 2 年，78.7%；p <0.001 两次比较均）。REPAC 系统还导致 EMS 避免率降低，从 4.4%降至 1.8%（前比后 1），1 年后进一步改善至 0.6%（p <0.001 两次比较均）。
通过实时集成电子监测系统主动选择 EMS 目的地可增强区域能力和流程管理，同时显著减少救护车分流。
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