Burnett Aaron M, Haley Kari B, Milder Matthew F, Peterson Bjorn K, Duren Joey, Stevens Andrew, Hermes Danielle M, Nystrom Paul, Lippert Joseph, Moberg Jennifer L, Isenberger Kurt M
Emergency Medicine/EMS, Regions Hospital, Saint Paul, Minnesota, USA.
Emergency Medicine/EMS, Allina Medical Transportation, Saint Paul, Minnesota, USA.
Prehosp Emerg Care. 2024;28(5):712-718. doi: 10.1080/10903127.2023.2271567. Epub 2023 Nov 2.
During the COVID-19 pandemic, ambulance divert in our EMS system reached critical levels. We hypothesized that eliminating ambulance divert would not be associated with an increase in the average number of daily ambulance arrivals. Our study objective was to quantify the EMS and emergency department (ED) effects of eliminating ambulance divert during the COVID-19 pandemic.
Regional hospital divert data were obtained for the 10-county Twin Cities metro from MNTrac, a state-supported online system designed to allow hospitals to indicate their divert status to EMS. ED metrics are reported for a single Level I trauma center and were obtained by a deidentified data pull from our electronic medical record covering the 12 months prior to the elimination of divert (2021) and the 12 months after divert elimination (2022). The decision to eliminate divert occurred in November 2021, based on data available through October, with an implementation date of January 2022. The primary study outcome was to quantify the effect of the elimination of divert on the number of ambulances arriving per day at the study hospital.
Regional utilization of ambulance divert increased steadily by 859% from January to October 2021 when 355 individual divert events occurred, totaling 809 h (34 days). There was no significant difference in the number of ambulances that arrived to the study hospital in 2021 (30,774) vs 2022 (30,421) = 0.15. As compared to 2021, in 2022 there was no significant increase in mean ambulance arrivals per day (84/day vs 83/day, = 0.08), time to room Emergency Severity Index level 2 (ESI) patients (28 min vs 28 min, = 0.90), or time to obtain emergent head CT in acute "code stroke" patients (12 min vs 12 min, = 0.15). Ambulance turnaround interval in the ED did not appreciably increase (16 min vs 17 min, = 0.15).
Elimination of ambulance divert was not associated with increases in the number of mean daily ambulance arrivals or EMS turnaround intervals, delays in ESI 2 patients being placed in beds, or prolonged time to head CT in stroke code patients.
在新冠疫情期间，我们急救医疗服务（EMS）系统中的救护车分流达到了危急水平。我们假设取消救护车分流不会导致每日救护车抵达数量的增加。我们的研究目的是量化在新冠疫情期间取消救护车分流对急救医疗服务和急诊科（ED）的影响。
从MNTrac获取了双城都会区10个县的区域医院分流数据，MNTrac是一个由州支持的在线系统，旨在让医院向急救医疗服务部门表明其分流状态。报告了一家一级创伤中心的急诊科指标，这些指标是通过对我们的电子病历进行去识别化数据提取获得的，涵盖取消分流前的12个月（2021年）和取消分流后的12个月（2022年）。取消分流的决定于2021年11月做出，基于截至10月的可用数据，实施日期为2022年1月。主要研究结果是量化取消分流对研究医院每日抵达救护车数量的影响。
2021年1月至10月，救护车分流的区域使用率稳步上升了859%，期间发生了355次单独的分流事件，总计809小时（34天）。2021年抵达研究医院的救护车数量（30,774辆）与2022年（30,421辆）相比无显著差异（ = 0.15）。与2021年相比，2022年每日平均救护车抵达数量（84辆/天对83辆/天， = 0.08）、急诊严重程度指数（ESI）2级患者进入病房的时间（28分钟对28分钟， = 0.90）或急性“卒中代码”患者获得紧急头部CT的时间（12分钟对12分钟， = 0.15）均无显著增加。急诊科的救护车周转间隔没有明显增加（16分钟对17分钟， = 0.15）。
取消救护车分流与每日平均救护车抵达数量增加、急救医疗服务周转间隔延长、ESI 2级患者安置床位延迟或卒中代码患者头部CT检查时间延长无关。
