Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.
Health Serv Res. 2022 Apr;57(2):300-310. doi: 10.1111/1475-6773.13903. Epub 2021 Nov 24.
Guidelines recommend emergency medical services (EMS) patients to be transported to the nearest appropriate emergency department (ED). Our objective was to estimate the prevalence of EMS transport to an ED other than the nearest ED ("potential bypassing").
Illinois Prehospital Patient Care Report Data of EMS transports (July 2019 to December 2019).
DATA COLLECTION/EXTRACTION METHODS: We identified all EMS ground transports with an advanced life-support (ALS) paramedic to an ED for patients aged 21 years and older. Using street address of incident location, we performed geocoding and driving route analyses and obtained estimated driving distance and time to the destination ED and alternative EDs.
Our main outcomes were dichotomous indicators of potential bypassing of the nearest ED based on distance and time. As secondary outcomes we examined potential bypassing indicators based on excess driving distance and time.
We used Poisson regression models to obtain adjusted relative rates of potential bypassing indicators by acuity level, primary impression, patient demographics and geographic characteristics.
Our study cohort of 361,051 EMS transports consisted of 5.8% critical, 37.2% emergent and 57.0% low acuity cases transported to 222 EDs. The observed rate of potential bypassing was approximately 34% of cases for each acuity level. Treating the cardiovascular primary impression code group as the reference case, we found small to no differences in potential bypassing rates across other primary impression code groups of all acuity levels, with the exception of critical acuity trauma cases for which potential bypassing rate was 64% higher (incidence rate ratio = 1.64, 95% confidence interval, 1.54-1.74). Compared to zip codes with one ED within a 5-mile vicinity, potential bypassing was higher in areas with no ED or multiple EDs within a 5-mile vicinity.
Approximately one-third of EMS transports potentially bypassed the nearest ED. EMS transport destination may be motivated by factors other than proximity.
指南建议将急救医疗服务（EMS）患者转运至最近的合适急诊部（ED）。我们的目的是评估将 EMS 转运至非最近 ED（“潜在绕过”）的患者比例。
伊利诺伊州院前患者护理报告 EMS 转运数据（2019 年 7 月至 2019 年 12 月）。
数据收集/提取方法：我们确定了所有配备高级生命支持（ALS）护理员的 EMS 地面转运患者，这些患者年龄在 21 岁及以上，转运至 ED。我们使用事件地点的街道地址进行地理编码和驾驶路线分析，获得到达目的地 ED 和替代 ED 的估计驾驶距离和时间。
我们的主要结果是基于距离和时间的最近 ED 潜在绕过的二项指标。作为次要结果，我们根据额外的驾驶距离和时间检查潜在绕过指标。
我们使用泊松回归模型，根据严重程度级别、主要印象、患者人口统计学特征和地理特征，获得潜在绕过指标的调整相对率。
我们的 361,051 例 EMS 转运研究队列包括 5.8%的危急病例、37.2%的紧急病例和 57.0%的低严重程度病例，转运至 222 个 ED。每种严重程度水平的潜在绕过发生率约为 34%。以心血管主要印象代码组为参考病例，我们发现其他主要印象代码组在所有严重程度水平的潜在绕过率差异较小，除了危急创伤病例，其潜在绕过率高出 64%（发病率比=1.64，95%置信区间为 1.54-1.74）。与 5 英里范围内只有一个 ED 的邮政编码相比，在 5 英里范围内没有 ED 或有多个 ED 的地区，潜在绕过的可能性更高。
大约三分之一的 EMS 转运可能绕过了最近的 ED。EMS 转运目的地可能受到接近程度以外的因素驱动。
