1 Department of Emergency Medicine, University of California, San Diego, California USA.
2 Health Disaster Management/ Emergency Medical Services, Orange County Health Care Agency, UCLA School of Public Health and David Geffen School of Medicine at UCLA, Los Angeles, California USA.
Prehosp Disaster Med. 2014 Feb;29(1):27-31. doi: 10.1017/S1049023X13009242. Epub 2014 Jan 22.
While several reports discuss controversies regarding ambulance diversion from acute care hospitals and the mortality, financial, and resource effects, there is scant literature related to the effect of hospital characteristics.
HYPOTHESIS/PROBLEM: The objective of this study was to describe specific paramedic receiving center characteristics that are associated with ambulance diversion rates in an Emergency Medical Services system.
A retrospective observational study design was used. The study was performed in a suburban EMS system with 27 paramedic receiving centers studied; one additional hospital present at the beginning of the study period (2000-2008) was excluded due to lack of recent data. Hospital-level and population-level characteristics were gathered, including diversion rate (hours on diversion/total hours open), for-profit status, number of specialty services (including trauma, burn, cardiovascular surgery, renal transplant services, cardiac catheterization capability [both interventional and diagnostic], and burn surgery), average inpatient bed occupancy rate (total patient days/licensed bed days), annual emergency department (ED) volume (patients per year), ED admission rate (percent of ED patients admitted), and percent of patients leaving without being seen. Demographic characteristics included percent of persons in each hospital's immediate census tract below the 100% and 200% poverty lines (each considered separately), and population density within the census tract. Bivariate and regression analyses were performed.
Diversion rates for the 27 centers ranged from 0.3%-14.5% (median 4.5%). Average inpatient bed occupancy rate and presence of specialty services were correlated with an increase in diversion rate; occupancy rate showed a 0.08% increase in diversion hours per 1% increase in occupancy rate (95% CI, 0.01%-0.16%), and hospitals with specialty services had, on average, a 4.1% higher diversion rate than other hospitals (95% CI, 1.6%-6.7%). Other characteristics did not show a statistically significant effect. When a regression was performed, only the presence of specialty services was related to the ambulance diversion rate.
Hospitals in this study providing specialty services were more likely to have higher diversion rates. This may result in increased difficulty getting patients requiring specialty care to centers able to provide the needed level of service. Major limitations include the retrospective nature of the study, as well as reliance on multiple data systems.
尽管有几项报告讨论了急救医院救护车转移的争议以及对死亡率、财务和资源的影响，但与医院特征相关的文献却很少。
假设/问题：本研究的目的是描述与急救医疗服务系统中的救护车转移率相关的特定医疗急救员接收中心特征。
采用回顾性观察研究设计。该研究在一个郊区的紧急医疗服务系统中进行，共研究了 27 个医疗急救员接收中心；由于缺乏近期数据，在研究初期（2000-2008 年）存在的另一家医院被排除在外。收集了医院层面和人口层面的特征，包括转移率（转移时间/开放总时间）、营利状态、专业服务数量（包括创伤、烧伤、心血管外科、肾移植服务、心脏导管能力[包括介入和诊断]和烧伤手术）、平均住院病床占用率（总患者天数/许可病床天数）、每年急诊部（ED）量（每年患者数）、ED 入院率（ED 患者入院百分比）和未就诊离开的患者百分比。人口统计学特征包括每个医院所在的立即普查区的贫困人口比例（每个比例分别考虑）和 200%贫困线以下的人口比例，以及普查区内的人口密度。进行了双变量和回归分析。
27 个中心的转移率范围为 0.3%-14.5%（中位数为 4.5%）。平均住院病床占用率和专业服务的存在与转移率的增加相关；病床占用率每增加 1%，转移时间就增加 0.08%（95%置信区间，0.01%-0.16%），提供专业服务的医院的转移率平均比其他医院高 4.1%（95%置信区间，1.6%-6.7%）。其他特征没有显示出统计学上的显著影响。当进行回归分析时，只有专业服务的存在与救护车转移率相关。
本研究中提供专业服务的医院更有可能出现更高的转移率。这可能导致需要专科护理的患者更难被送到能够提供所需服务水平的中心。主要限制包括研究的回顾性性质，以及对多个数据系统的依赖。
