Department of Emergency Medicine, Cleveland Clinic Akron General, 1 Akron General Ave., Akron, OH 44307, USA; Northeast Ohio Medical University, 4209 SR-44, Rootstown, OH 44272, USA.
Department of Emergency Medicine, Cleveland Clinic Akron General, 1 Akron General Ave., Akron, OH 44307, USA.
Am J Emerg Med. 2023 Jun;68:38-41. doi: 10.1016/j.ajem.2023.02.021. Epub 2023 Feb 21.
Emergency departments (EDs) play a critical role in the US healthcare system. As freestanding EDs (FSEDs) are integrated into the acute care landscape, local EMS providers are transporting to these facilities, which may be closer in proximity and provide faster turnaround times. We hypothesized that patients transported via EMS to a freestanding ED required fewer tests and are admitted less frequently than those transported to a HBED. Our objective was to compare testing frequency and admission rates between patients transported via EMS to a FSED vs. HBED.
This was a retrospective cohort study of all patients who presented within a large integrated hospital system via EMS to one of 10 HBEDs or one of 6 FSEDs between April 1, 2020 - May 1, 2021. Categorical variables are presented as frequencies and percentages and comparisons between groups were obtained using chi squared tests. Continuous variables are presented as mean and standard deviation and p-values comparing groups were obtained using t-tests. Multiple logistic regression was used to assess the effect of ED type on admission status, labs ordered, and testing performed.
A total of 123,120 encounters were included in our study. Mean age at the FSEDs was 59.9 vs. 61.3 at the HBEDs. At the FSEDs 55.6% (n = 4675) were female vs. 53.0% (n = 60,809) at the HBEDs. At the FSEDs 82.0% (n = 6805) were White vs. 60.7% (n = 68,430) at the HBEDs. We found 50.0% (n = 3974) had Medicare at the FSEDs vs 50.9% (n = 55,372) at the FSEDs. At the FSEDs, 69.5% (n = 5846) had bloodwork vs. 82.4% (n = 94,512) at the HBEDs; 68.3% (n = 5745) had an x-ray at the FSEDs vs. 70.7% (n = 81,089) at the HBEDs; 40.1% (n = 3370) had a CT scan at the FSEDs vs. 44.9% (n = 51,503) at the HBEDs; and 40.6% (n = 3412) were admitted at the FSEDs vs. 56.1% (n = 64,355) at the HBEDs. After controlling for Charlson Comorbidity Index, acuity, age, gender, sex, insurance and race, patients in FSEDs were 35% less likely to be admitted as compared to HBEDs.
Patients brought in via EMS to a FSED were less likely to have blood work, x-ray, or CT scan, and were less likely to be admitted to the hospital than those transported to a HBED.
急诊科（ED）在美国医疗体系中起着至关重要的作用。随着独立急诊部（FSED）融入急性护理领域，当地的紧急医疗服务（EMS）提供者正在将患者转运至这些设施，这些设施可能距离更近，周转时间更快。我们假设通过 EMS 转运至独立急诊部的患者比转运至综合急诊部（HBED）的患者需要的检查更少，住院的频率也更低。我们的目的是比较通过 EMS 转运至 FSED 与 HBED 的患者的检查频率和住院率。
这是一项回顾性队列研究，纳入了 2020 年 4 月 1 日至 2021 年 5 月 1 日期间，通过 EMS 至 10 个 HBED 或 6 个 FSED 之一就诊于大型综合医院系统的所有患者。分类变量以频率和百分比表示，组间比较采用卡方检验。连续变量以平均值和标准差表示，组间比较采用 t 检验。采用多因素逻辑回归评估 ED 类型对入院状态、医嘱检查和检查结果的影响。
本研究共纳入 123120 例患者。FSED 组的平均年龄为 59.9 岁，HBED 组为 61.3 岁。FSED 组女性占 55.6%（n=4675），HBED 组为 53.0%（n=60809）。FSED 组白人占 82.0%（n=6805），HBED 组为 60.7%（n=68430）。FSED 组有 50.0%（n=3974）的患者有医疗保险，HBED 组为 50.9%（n=55372）。FSED 组有 69.5%（n=5846）的患者进行了血液检查，HBED 组为 82.4%（n=94512）；FSED 组有 68.3%（n=5745）的患者进行了 X 光检查，HBED 组为 70.7%（n=81089）；FSED 组有 40.1%（n=3370）的患者进行了 CT 扫描，HBED 组为 44.9%（n=51503）；FSED 组有 40.6%（n=3412）的患者入院，HBED 组为 56.1%（n=64355）。在校正 Charlson 合并症指数、严重程度、年龄、性别、保险和种族后，与 HBED 相比，FSED 组的患者入院率降低了 35%。
通过 EMS 转运至 FSED 的患者进行血液检查、X 光检查或 CT 扫描的可能性较低，且与转运至 HBED 的患者相比，住院的可能性较低。
