Department of Emergency Medicine, Boston University, Boston, Massachusetts 02118, USA. mj
Prehosp Emerg Care. 2012 Apr-Jun;16(2):198-203. doi: 10.3109/10903127.2011.640418. Epub 2011 Dec 22.
On July 12, 2010, Boston Medical Center (BMC), the busiest emergency department (ED) in Massachusetts, with more than 100,000 adult patient visits per year, consolidated its two fully functional EDs into one. In preparation for this consolidation, BMC implemented systems changes to mitigate potential negative effects on both BMC and emergency medical services (EMS) providers, including Boston Emergency Medical Services (Boston EMS), the provider of 9-1-1 EMS to the City of Boston.
To examine the impact of the closure of an ED on an urban EMS system in a setting where ambulance diversion is not allowed.
We performed a before-and-after study that examined the effects of an ED closure on BMC and Boston EMS. We examined ED and Boston EMS volumes and ambulance turnaround intervals from June 1, 2010, to July 11, 2010 (preclosure) as compared with July 12, 2010, to August 26, 2010 (postclosure). Mean ED and Boston EMS volumes and Boston EMS turnaround intervals were calculated in four-hour shifts. We used multivariate analysis to analyze electronic medical systems data from BMC and Boston EMS and linear regression. We used autoregressive integrated moving average (ARIMA) models to determine the effect of the ED closure on turnaround intervals, ED volumes, and transport volumes. All analyses were adjusted for shift, ED volume, day of the week, and citywide EMS transport volumes.
After ED closure, there was a statistically significant increase of 0.89 minutes (p = 0.02) in the mean EMS turnaround intervals. Additionally, the total ED volume decreased by 3.67 visits per shift (p < 0.001). The ratio of patients transported by Boston EMS to BMC remained unchanged (p = 0.11) for two weeks before and two weeks after the closure.
The closure of one ED resulted in a statistically significant increase in turnaround intervals and a significant decrease in ED volume independent of EMS volumes. In the absence of ambulance diversion, ratios of EMS turnaround intervals and EMS volumes according to hospital destination can be used as alternatives to ambulance diversion times to examine the effects of system-level changes such as closure of an ED on an urban EMS system.
2010 年 7 月 12 日，马萨诸塞州最繁忙的急诊部（ED）波士顿医疗中心（BMC）将其两个功能齐全的 ED 合并为一个，每年接待超过 100,000 名成年患者。在为此次合并做准备时，BMC 实施了系统变革，以减轻对 BMC 和紧急医疗服务（EMS）提供商（包括为波士顿市提供 9-1-1 EMS 的波士顿紧急医疗服务（Boston EMS））的潜在负面影响。
在不允许救护车分流的情况下，研究关闭 ED 对城市 EMS 系统的影响。
我们进行了一项前后对照研究，以研究 ED 关闭对 BMC 和 Boston EMS 的影响。我们研究了 ED 和 Boston EMS 的数量以及救护车周转时间，从 2010 年 6 月 1 日至 7 月 11 日（关闭前）与 2010 年 7 月 12 日至 8 月 26 日（关闭后）进行比较。每四小时 shift 计算平均 ED 和 Boston EMS 量和 Boston EMS 周转时间。我们使用多元分析分析了来自 BMC 和 Boston EMS 的电子医疗系统数据以及线性回归。我们使用自回归综合移动平均（ARIMA）模型来确定 ED 关闭对周转时间、ED 量和转运量的影响。所有分析均根据 shift、ED 量、星期几和全市范围内的 EMS 转运量进行了调整。
ED 关闭后，EMS 平均周转时间平均增加了 0.89 分钟（p = 0.02）。此外，每个 shift 的 ED 总就诊量减少了 3.67 人次（p < 0.001）。在关闭前后两周内，由 Boston EMS 转运到 BMC 的患者比例保持不变（p = 0.11）。
关闭一个 ED 导致周转时间的统计学显著增加，并且与 EMS 量无关的 ED 量显著减少。在没有救护车分流的情况下，可以根据医院目的地将 EMS 周转时间和 EMS 量的比例用作救护车分流时间的替代方法，以检查 ED 关闭等系统层面变化对城市 EMS 系统的影响。
