Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
Am J Emerg Med. 2020 Oct;38(10):2244.e3-2244.e6. doi: 10.1016/j.ajem.2020.05.047. Epub 2020 May 22.
To describe characteristics of encounters in U.S. emergency departments (EDs) brought by interfacility transport by emergency medical services (EMS) from other EDs or urgent care settings.
We performed a cross-sectional study of the National Hospital Ambulatory Medical Care Survey, a multistage probability survey of nonfederal of visits to U.S. EDS. We evaluated patients who were brought to the ED as an interfacility transport by EMS from another ED or urgent care setting between 2014 and 2017. We report demographics, clinical characteristics and treatment factors of ED encounters brought interfacility transport and assessed factors associated with discharge from the receiving ED.
Of 562.9 million ED encounters during the assessed period, 4.5 million were brought by interfacility transport by EMS (1.1 million per year). This represented 0.8% (95% CI 0.6-1.0%) of all ED encounters and 5.3% (95% CI 4.4-6.3%) of ED encounters transported by EMS. Most encounters brought by interfacility transport were adults (85%) who were publicly insured (62%). 39% had at least one abnormal vital sign. Most encounters received diagnostic testing (84%) and were seen within 30 min of presentation (61%). 54% were admitted, and 36% were discharged from the ED. Encounters without chronic complex conditions and with normal triage vital signs were associated with ED discharge (p < 0.01).
Interfacility transports between EDs transported by EMS account for <1% of ED encounters in the U.S. Nearly 40% of such encounters are ultimately discharged. Further research is needed to identify a low-risk cohort among patients in need of secondary transport.
描述由紧急医疗服务（EMS）从其他急诊部或紧急护理机构转运至美国急诊部（ED）的患者的就诊特征。
我们对美国国家医院门诊医疗调查进行了一项横断面研究，该调查是对美国 ED 非联邦就诊的多阶段概率调查。我们评估了 2014 年至 2017 年期间因 EMS 从另一家 ED 或紧急护理机构转运至 ED 的患者。我们报告了 ED 就诊的人口统计学、临床特征和治疗因素，并评估了与接收 ED 出院相关的因素。
在所评估的期间内，5.629 亿次 ED 就诊中有 450 万人次是由 EMS 转运的，每年转运 110 万人次。这占所有 ED 就诊的 0.8%（95%CI 0.6-1.0%）和 EMS 转运的 ED 就诊的 5.3%（95%CI 4.4-6.3%）。大多数由转运带来的就诊为成年人（85%），并由公共保险承保（62%）。39%的患者至少有一个异常生命体征。大多数就诊接受了诊断性检查（84%），并在就诊后 30 分钟内得到诊治（61%）。54%的患者被收治入院，36%的患者从 ED 出院。无慢性复杂疾病且分诊生命体征正常的就诊与 ED 出院相关（p<0.01）。
由 EMS 转运的 ED 之间的转运量占美国 ED 就诊量的<1%。近 40%的转运就诊最终出院。需要进一步研究以确定需要二次转运的患者中的低风险人群。
