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Liu Z, Feng Y, Li J, Tao H, Liu Z, Li X. Improving urban emergency medical service systems through brownfield transformation in Huangshi, China. Sci Rep 2024; 14:14946. [PMID: 38942906 PMCID: PMC11213939 DOI: 10.1038/s41598-024-66080-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 06/26/2024] [Indexed: 06/30/2024] Open
Abstract
A comprehensive emergency medical service (EMS) system significantly enhances a city's capacity to prevent and mitigate disasters. Using Huangshi as a case study, this research evaluated the service radium coverage rate of the current EMS system by examining its transport capacity, population density, and prevalence rate, finding it to be only 61.49% with an inefficient spatial layout. To address this, we proposed transforming urban brownfields into EMS parks. By selecting the most suitable brownfields based on capacity and service radius, we increased the coverage rate to 90.21%. We introduced a new "consultation-referral" model, where existing EMS facilities serve as pre-diagnosis and triage centers, and the urban brownfield EMS parks function as isolation and centralized treatment centers. GIS network analysis confirmed the feasibility, showing all transit times to be under 30 min. The methodology outlined in this study-comprising "demand assessment, supply optimization, and feasibility verification"-not only strengthens the city's EMS system but also facilitates the renewal of urban brownfields. This approach can serve as a valuable reference for enhancing EMS systems in other cities.
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Affiliation(s)
- Zhiping Liu
- State Key Laboratory for Tunnel Engineering, China University of Mining and Technology (Beijing), D11, Xueyuan Road, Haidian District, Beijing, China
- School of Mechanics and Civil Engineering, China University of Mining and Technology (Beijing), Beijing, 100083, China
| | - Yingxue Feng
- School of Mechanics and Civil Engineering, China University of Mining and Technology (Beijing), Beijing, 100083, China
| | - Jing Li
- State Key Laboratory for Tunnel Engineering, China University of Mining and Technology (Beijing), D11, Xueyuan Road, Haidian District, Beijing, China
- School of Mechanics and Civil Engineering, China University of Mining and Technology (Beijing), Beijing, 100083, China
| | - Haoyu Tao
- State Key Laboratory for Tunnel Engineering, China University of Mining and Technology (Beijing), D11, Xueyuan Road, Haidian District, Beijing, China
- School of Mechanics and Civil Engineering, China University of Mining and Technology (Beijing), Beijing, 100083, China
| | - Zhen Liu
- State Key Laboratory for Tunnel Engineering, China University of Mining and Technology (Beijing), D11, Xueyuan Road, Haidian District, Beijing, China
- School of Mechanics and Civil Engineering, China University of Mining and Technology (Beijing), Beijing, 100083, China
| | - Xiaodan Li
- State Key Laboratory for Tunnel Engineering, China University of Mining and Technology (Beijing), D11, Xueyuan Road, Haidian District, Beijing, China.
- School of Mechanics and Civil Engineering, China University of Mining and Technology (Beijing), Beijing, 100083, China.
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Li S, Dong X, Li D, Zhang H, Zhou S, Maimaitiming M, Ma J, Li N, Zhou Q, Jin Y, Zheng ZJ. Inequities in ambulance allocation associated with transfer delay and mortality in acute coronary syndrome patients: evidence from 89 emergency medical stations in China. Int J Equity Health 2022; 21:178. [PMID: 36527098 PMCID: PMC9756777 DOI: 10.1186/s12939-022-01777-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 10/16/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Allocation of healthcare resources has a great influence on treatment and outcome of patients. This study aimed to access the inequality of ambulance allocation across regions, and estimate the associations between ambulance density and pre-hospital transfer time and mortality of acute coronary syndromes (ACS) patients. METHODS This cross-sectional study was based on an integrated database of electronic medical system for 3588 ACS patients from 31 hospitals, ambulance information of 89 emergency medical stations, and public geographical information of 8 districts in Shenzhen, China. The primary outcomes were the associations between ambulance allocation and transfer delay and in-hospital mortality of ACS patients. The Theil index and Gini coefficient were used to assess the fairness and inequality degree of ambulance allocation. Logistic regression was used to model the associations. RESULTS There was a significant inequality in ambulance allocation in Shenzhen (Theil index: 0.59), and the inequality of inter-districts (Theil index: 0.38) was greater than that of intra-districts (Theil index: 0.21). The gap degree of transfer delay, ambulance allocation, and mortality across districts resulted in a Gini coefficient of 0.35, 0.53, 0.65, respectively. Ambulance density was negatively associated with pre-hospital transfer time (OR = 0.79, 95%CI: 0.64,0.97, P = 0.026), with in-hospital mortality (OR = 0.31, 95%CI:0.14,0.70, P = 0.005). The ORs of Theil index in transfer time and in-hospital mortality were 1.09 (95%CI:1.01,1.10, P < 0.001) and 1.80 (95%CI:1.15,3.15, P = 0.009), respectively. CONCLUSIONS Regional inequities existed in ambulance allocation and has a significant impact on pre-hospital transfer delay and in-hospital mortality of ACS patients. It was suggested to increase the ambulance accessibility and conduct health education for public.
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Affiliation(s)
- Siwen Li
- Shenzhen Center for Prehospital Care, 3 Meigang South Street, West Nigang Road, Futian District, Shenzhen, 518025 China ,grid.11135.370000 0001 2256 9319Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191 China ,grid.11135.370000 0001 2256 9319Institute for Global Health and Development, Peking University, Beijing, China
| | - Xuejie Dong
- grid.11135.370000 0001 2256 9319Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191 China ,grid.11135.370000 0001 2256 9319Institute for Global Health and Development, Peking University, Beijing, China
| | - Dongmei Li
- Shenzhen Center for Prehospital Care, 3 Meigang South Street, West Nigang Road, Futian District, Shenzhen, 518025 China
| | - Hongjuan Zhang
- Shenzhen Center for Prehospital Care, 3 Meigang South Street, West Nigang Road, Futian District, Shenzhen, 518025 China
| | - Shuduo Zhou
- grid.11135.370000 0001 2256 9319Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191 China ,grid.11135.370000 0001 2256 9319Institute for Global Health and Development, Peking University, Beijing, China
| | - Mailikezhati Maimaitiming
- grid.11135.370000 0001 2256 9319Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191 China ,grid.11135.370000 0001 2256 9319Institute for Global Health and Development, Peking University, Beijing, China
| | - Junxiong Ma
- grid.11135.370000 0001 2256 9319Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191 China ,grid.11135.370000 0001 2256 9319Institute for Global Health and Development, Peking University, Beijing, China
| | - Na Li
- grid.11135.370000 0001 2256 9319Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191 China ,grid.11135.370000 0001 2256 9319Institute for Global Health and Development, Peking University, Beijing, China
| | - Qiang Zhou
- Shenzhen Center for Prehospital Care, 3 Meigang South Street, West Nigang Road, Futian District, Shenzhen, 518025 China
| | - Yinzi Jin
- grid.11135.370000 0001 2256 9319Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191 China ,grid.11135.370000 0001 2256 9319Institute for Global Health and Development, Peking University, Beijing, China
| | - Zhi-Jie Zheng
- grid.11135.370000 0001 2256 9319Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191 China ,grid.11135.370000 0001 2256 9319Institute for Global Health and Development, Peking University, Beijing, China
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Dawson LP, Andrew E, Stephenson M, Nehme Z, Bloom J, Cox S, Anderson D, Lefkovits J, Taylor AJ, Kaye D, Smith K, Stub D. The influence of ambulance offload time on 30-day risks of death and re-presentation for patients with chest pain. Med J Aust 2022; 217:253-259. [PMID: 35738570 PMCID: PMC9545565 DOI: 10.5694/mja2.51613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/15/2022] [Accepted: 03/14/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To assess whether ambulance offload time influences the risks of death or ambulance re-attendance within 30 days of initial emergency department (ED) presentations by adults with non-traumatic chest pain. DESIGN, SETTING Population-based observational cohort study of consecutive presentations by adults with non-traumatic chest pain transported by ambulance to Victorian EDs, 1 January 2015 - 30 June 2019. PARTICIPANTS Adults (18 years or older) with non-traumatic chest pain, excluding patients with ST elevation myocardial infarction (pre-hospital electrocardiography) and those who were transferred between hospitals or not transported to hospital (eg, cardiac arrest or death prior to transport). MAIN OUTCOME MEASURES Primary outcome: 30-day all-cause mortality (Victorian Death Index data). SECONDARY OUTCOME Transport by ambulance with chest pain to ED within 30 days of initial ED presentation. RESULTS We included 213 544 people with chest pain transported by ambulance to EDs (mean age, 62 [SD, 18] years; 109 027 women [51%]). The median offload time increased from 21 (IQR, 15-30) minutes in 2015 to 24 (IQR, 17-37) minutes during the first half of 2019. Three offload time tertiles were defined to include approximately equal patient numbers: tertile 1 (0-17 minutes), tertile 2 (18-28 minutes), and tertile 3 (more than 28 minutes). In multivariable models, 30-day risk of death was greater for patients in tertile 3 than those in tertile 1 (adjusted rates, 1.57% v 1.29%; adjusted risk difference, 0.28 [95% CI, 0.16-0.42] percentage points), as was that of a second ambulance attendance with chest pain (adjusted rates, 9.03% v 8.15%; adjusted risk difference, 0.87 [95% CI, 0.57-1.18] percentage points). CONCLUSIONS Longer ambulance offload times are associated with greater 30-day risks of death and ambulance re-attendance for people presenting to EDs with chest pain. Improving the speed of ambulance-to-ED transfers is urgently required.
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Affiliation(s)
- Luke P Dawson
- Royal Melbourne HospitalMelbourneVIC
- Centre for Research and Evaluation, Ambulance VictoriaMelbourneVIC
- Monash UniversityMelbourneVIC
| | - Emily Andrew
- Centre for Research and Evaluation, Ambulance VictoriaMelbourneVIC
- Ambulance VictoriaMelbourneVIC
| | - Michael Stephenson
- Centre for Research and Evaluation, Ambulance VictoriaMelbourneVIC
- Alfred HealthMelbourneVIC
| | - Ziad Nehme
- Centre for Research and Evaluation, Ambulance VictoriaMelbourneVIC
- Alfred HealthMelbourneVIC
| | - Jason Bloom
- Centre for Research and Evaluation, Ambulance VictoriaMelbourneVIC
- Monash UniversityMelbourneVIC
| | | | | | - Jeffrey Lefkovits
- Royal Melbourne HospitalMelbourneVIC
- Centre for Research and Evaluation, Ambulance VictoriaMelbourneVIC
| | - Andrew J Taylor
- Centre for Research and Evaluation, Ambulance VictoriaMelbourneVIC
- Monash UniversityMelbourneVIC
| | - David Kaye
- Monash UniversityMelbourneVIC
- Baker Heart Research Institute (BHRI)MelbourneVIC
| | - Karen Smith
- Ambulance VictoriaMelbourneVIC
- Alfred HealthMelbourneVIC
| | - Dion Stub
- Centre for Research and Evaluation, Ambulance VictoriaMelbourneVIC
- Monash UniversityMelbourneVIC
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Crilly J, Bartlett D, Sladdin I, Pellatt R, Young JT, Ham W, Porter L. Patient profile and outcomes of traumatic injury: The impact of mode of arrival to the emergency department. Collegian 2022. [DOI: 10.1016/j.colegn.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Impacts of an EMS Hospital Liaison Program on Ambulance Offload Times: A Preliminary Analysis. Prehosp Disaster Med 2021; 37:45-50. [PMID: 34852868 DOI: 10.1017/s1049023x2100128x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Ambulance patients who are unable to be quickly transferred to an emergency department (ED) bed represent a key contributing factor to ambulance offload delay (AOD). Emergency department crowding and associated AOD are exacerbated by multiple factors, including infectious disease outbreaks such as the coronavirus disease 2019 (COVID-19) pandemic. Initiatives to address AOD present an opportunity to streamline ambulance offload procedures while improving patient outcomes. STUDY OBJECTIVE The goal of this study was to evaluate the initial outcomes and impact of a novel Emergency Medical Service (EMS)-based Hospital Liaison Program (HLP) on ambulance offload times (AOTs). METHODS Ambulance offload times associated with EMS patients transported to a community hospital six months before and after HLP implementation were retrospectively analyzed using proportional significance tests, t-tests, and multiple regression analysis. RESULTS A proportional increase in incidents in the zero to <30 minutes time category after program implementation (+2.96%; P <.01) and a commensurate decrease in the proportion of incidents in the 30 to <60 minutes category (-2.65%; P <.01) were seen. The fully adjusted regression model showed AOT was 16.31% lower (P <.001) after HLP program implementation, holding all other variables constant. CONCLUSION The HLP is an innovative initiative that constitutes a novel pathway for EMS and hospital systems to synergistically enhance ambulance offload procedures. The greatest effect was demonstrated in patients exhibiting potentially life-threatening symptoms, with a reduction of approximately three minutes. While small, this outcome was a statistically significant decrease from the pre-intervention period. Ultimately, the HLP represents an additional strategy to complement existing approaches to mitigate AOD.
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Walker KJ, Jiarpakdee J, Loupis A, Tantithamthavorn C, Joe K, Ben-Meir M, Akhlaghi H, Hutton J, Wang W, Stephenson M, Blecher G, Buntine P, Sweeny A, Turhan B. Predicting Ambulance Patient Wait Times: A Multicenter Derivation and Validation Study. Ann Emerg Med 2021; 78:113-122. [PMID: 33972127 DOI: 10.1016/j.annemergmed.2021.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/31/2021] [Accepted: 02/05/2021] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE To derive and internally and externally validate machine-learning models to predict emergency ambulance patient door-to-off-stretcher wait times that are applicable to a wide variety of emergency departments. METHODS Nine emergency departments provided 3 years (2017 to 2019) of retrospective administrative data from Australia. Descriptive and exploratory analyses were undertaken on the datasets. Statistical and machine-learning models were developed to predict wait times at each site and were internally and externally validated. RESULTS There were 421,894 episodes analyzed, and median site off-load times varied from 13 (interquartile range [IQR], 9 to 20) to 29 (IQR, 16 to 48) minutes. The global site prediction model median absolute errors were 11.7 minutes (95% confidence interval [CI], 11.7 to 11.8) using linear regression and 12.8 minutes (95% CI, 12.7 to 12.9) using elastic net. The individual site model prediction median absolute errors varied from the most accurate at 6.3 minutes (95% CI, 6.2 to 6.4) to the least accurate at 16.1 minutes (95% CI, 15.8 to 16.3). The model technique performance was the same for linear regression, random forests, elastic net, and rolling average. The important variables were the last k-patient average waits, triage category, and patient age. The global model performed at the lower end of the accuracy range compared with models for the individual sites but was within tolerable limits. CONCLUSION Electronic emergency demographic and flow information can be used to estimate emergency ambulance patient off-stretcher times. Models can be built with reasonable accuracy for multiple hospitals using a small number of point-of-care variables.
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Affiliation(s)
- Katie J Walker
- Cabrini Emergency Department, Malvern, Melbourne, Victoria, Australia; Cabrini Institute, Malvern, Melbourne, Victoria, Australia; Casey Emergency Department, Berwick, Melbourne, Victoria, Australia; School of Clinical Sciences at Monash Health, Monash University, Clayton, Melbourne, Victoria, Australia.
| | - Jirayus Jiarpakdee
- Department of Software Systems and Cybersecurity, Monash University, Clayton, Melbourne, Victoria, Australia
| | - Anne Loupis
- Cabrini Institute, Malvern, Melbourne, Victoria, Australia; School of Clinical Sciences at Monash Health, Monash University, Clayton, Melbourne, Victoria, Australia
| | - Chakkrit Tantithamthavorn
- Department of Software Systems and Cybersecurity, Monash University, Clayton, Melbourne, Victoria, Australia
| | - Keith Joe
- Cabrini Emergency Department, Malvern, Melbourne, Victoria, Australia; Monash Art, Design and Architecture, Monash University, Caulfield, Melbourne, Victoria, Australia
| | - Michael Ben-Meir
- Cabrini Emergency Department, Malvern, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Hamed Akhlaghi
- Emergency Department, St Vincent's Hospital, Fitzroy, Melbourne, Victoria, Australia
| | - Jennie Hutton
- Emergency Department, St Vincent's Hospital, Fitzroy, Melbourne, Victoria, Australia; Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Melbourne, Victoria, Australia
| | - Wei Wang
- Cabrini Institute, Malvern, Melbourne, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michael Stephenson
- Ambulance Victoria, Doncaster, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Community Emergency Health and Paramedic Practice, Frankston, Melbourne, Victoria, Australia
| | - Gabriel Blecher
- Cabrini Emergency Department, Malvern, Melbourne, Victoria, Australia; School of Clinical Sciences at Monash Health, Monash University, Clayton, Melbourne, Victoria, Australia; Monash Medical Centre, Emergency Department, Clayton, Melbourne, Victoria, Australia
| | - Paul Buntine
- Emergency Department, Box Hill Hospital, Eastern Health, Box Hill, Melbourne, Victoria, Australia; Eastern Health Clinical School, Monash University, Box Hill, Melbourne, Victoria, Australia
| | - Amy Sweeny
- Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia; Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - Burak Turhan
- Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland
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Choice of Transport to Hospital in Nonurban Areas in Life-Threatening Situations: A Qualitative Research. J Ambul Care Manage 2021; 44:155-165. [PMID: 33591130 DOI: 10.1097/jac.0000000000000375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The time it takes to begin treatment in life-threatening situations is critical. Ambulance transport to the hospital in such situations ensures quick and effective treatment but is not always readily available in nonurban areas, or not preferred by the public, for various reasons. The purpose of this qualitative study was to examine the factors that deter or encourage ambulance use in life-threatening situations in the geographic periphery from clients' perspectives. We conducted interviews with 71 patients in 3 medical centers who had arrived by ambulance or by private transport, and with the 3 emergency department directors. The findings revealed that awareness of the clinical situation and health literacy, accessibility of emergency services, geographical conditions, and social and economic factors are central in the decision to utilize this service. We detail research recommendations for strengthening public health literacy and access to services.
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Karamercan MA, Dündar ZD, Ergin M, VAN Meer O, Body R, Harjola VP, Verschuren F, Christ M, Golea A, Capsec J, Barletta C, Garcia-Castrillo L, Altuncı YA, Katırcı Y, Kelly AM, Laribi S. Seasonal variations of patients presenting dyspnea to emergency departments in Europe: Results from the EURODEM Study. Turk J Med Sci 2020; 50:1879-1886. [PMID: 32562519 PMCID: PMC7775711 DOI: 10.3906/sag-2002-221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/18/2020] [Indexed: 12/02/2022] Open
Abstract
Background/aim To describe seasonal variations in epidemiology, management, and short-term outcomes of patients in Europe presenting to an emergency department (ED) with a main complaint of dyspnea. Materials and methods An observational prospective cohort study was performed in 66 European EDs which included consecutive patients presenting to EDs with dyspnea as the main complaint during 3 72-h study periods. Data were collected on demographics, comorbidities, chronic treatment, prehospital treatment, mode of arrival of patient to ED, clinical signs at admission, treatment in the ED, ED diagnosis, discharge from ED, and in-hospital outcome. Results The study included 2524 patients with a median age of 69 (53–80) years old. Of the patients presented, 991 (39.3%) were in autumn, 849 (33.6%) were in spring, and 48 (27.1%) were in winter. The winter population was significantly older (P < 0.001) and had a lower rate of ambulance arrival to ED (P < 0.001). In the winter period, there was a higher rate for lower respiratory tract infection (35.1%), and patients were more hypertensive, more hypoxic, and more hyper/hypothermic compared to other seasons. The ED mortality was about 1% and, in hospital, mortality for admitted patients was 7.4%. Conclusion The analytic method and the outcome of this study may help to guide the allocation of ED resources more efficiently and to recommend seasonal ED management protocols based on the seasonal trend of dyspneic patients.
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Affiliation(s)
| | - Zerrin Defne Dündar
- Department of Emergency Medicine, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Mehmet Ergin
- Department of Emergency Medicine, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Oene VAN Meer
- Department of Emergency Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Richard Body
- Department of Emergency Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK,Department of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Veli-Pekka Harjola
- Department of Emergency Medicine, Faculty of Medicine, University of Helsinki, Helsinki, Finland,Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Franck Verschuren
- Department of Acute Medicine, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Micheal Christ
- Department of Emergency Medicine, Luzerner Kantonsspital, Luzern, Switzerland
| | - Adela Golea
- Department of Emergency Medicine, County Emergency Hospital Cluj-Napoca, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Jean Capsec
- Department of Public Health, Tours University Hospital, Tours, France
| | - Cinzia Barletta
- Department of Emergency Medicine, Santa Eugenio Hospital, Rome, Italy
| | | | - Yusuf Ali Altuncı
- Department of Emergency Medicine, Faculty of Medicine Hospital, Ege University, İzmir, Turkey
| | - Yavuz Katırcı
- Department of Emergency Medicine, Ankara Education and Research Hospital, Ankara, Turkey
| | - Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Australia,Department of Medicine, Melbourne Medical School – Western Precinct, The University of Melbourne, Melbourne, Australia
| | - Said Laribi
- Department of Emergency Medicine, Faculty of Medicine, Tours University, Tours, France
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Ahmed AA, Ibro SA, Melkamu G, Seid SS, Tesfaye T. Length of Stay in the Emergency Department and Its Associated Factors at Jimma Medical Center, Southwest Ethiopia. Open Access Emerg Med 2020; 12:227-235. [PMID: 33116958 PMCID: PMC7553249 DOI: 10.2147/oaem.s254239] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 09/18/2020] [Indexed: 11/23/2022] Open
Abstract
Background Prolonged emergency department stays can adversely affect patient outcomes leading to an increased length of hospital admission and higher mortality. Despite this fact, there are few data describing emergency department length of stay and associated factors in Ethiopia. Objective To assess length of stay in the emergency department and its associated factors among patients visited adult emergency department of Jimma Medical Center, Jimma town, southwest of Ethiopia. Methods Institution-based cross-sectional study was conducted from April 9, 2018 to May 11, 2018. Overall, 422 patients presented during study period were sequentially included in the study. A semi-structured questionnaire was used to collect data through interview, observation and medical record review. The collected data were cleaned, entered to Epi-data 3.1 and exported to SPSS version 21 for binary and multivariable logistic regression analysis. To identify factors associated with outcome variable, candidate variables were fitted to multivariable analysis, and those with P-values <0.05 were considered as significantly associated. Results More than one-third, 162 (38.4%), experienced prolonged length of stay in the emergency department. The odds of prolonged stay were higher among rural area residency (AOR, 3.0; CI, 1.279–7.042), evening presentation (AOR, 4.25; CI, 1.742–10.417), and night-time presentation (AOR, 14.93; CI, 4.22–52.63), and having at least one diagnostic investigation (AOR, 4.48; CI, 1.69–11.88). However, participants who did not experience shift changes of nurses during their stay (AOR, 0.003; CI, 0.001–0.010) had a less prolonged stay. Conclusion A significant proportion of patients experienced a prolonged stay at the emergency department. Age, rural residency, evening and night-time presentation, shift change and having a diagnostic investigation were predictors of prolonged stay. Thus, establishing time-targeted service for patients can reduce the length of stay.
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Affiliation(s)
| | - Shemsedin Amme Ibro
- School of Nursing and Midwifery, Jimma University, Jimma, Oromia Region, Ethiopia
| | - Gemechis Melkamu
- School of Medicine, Jimma University, Jimma, Oromia Region, Ethiopia
| | - Sheka Shemsi Seid
- School of Nursing and Midwifery, Jimma University, Jimma, Oromia Region, Ethiopia
| | - Temamen Tesfaye
- School of Nursing and Midwifery, Jimma University, Jimma, Oromia Region, Ethiopia
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Hughes-Gooding T, Dickson JM, O'Keeffe C, Mason SM. A data linkage study of suspected seizures in the urgent and emergency care system in the UK. Emerg Med J 2020; 37:605-610. [PMID: 32546473 PMCID: PMC7525779 DOI: 10.1136/emermed-2019-208820] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 04/11/2020] [Accepted: 04/29/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The urgent and emergency care (UEC) system is struggling with increased demand, some of which is clinically unnecessary. Patients suffering suspected seizures commonly present to EDs, but most seizures are self-limiting and have low risk of short-term adverse outcomes. We aimed to investigate the flow of suspected seizure patients through the UEC system using data linkage to facilitate the development of new models of care. METHODS We used a two-stage process of deterministic linking to perform a cross-sectional analysis of data from adults in a large region in England (population 5.4 million) during 2014. The core dataset comprised a total of 739 436 ambulance emergency incidents, 1 033 778 ED attendances and 362 358 admissions. RESULTS A high proportion of cases were successfully linked (86.9% ED-inpatient, 77.7% ED-ambulance). Suspected seizures represented 2.8% of all ambulance service incidents. 61.7% of these incidents led to dispatch of a rapid-response ambulance (8 min) and 72.1% were conveyed to hospital. 37 patients died before being conveyed to hospital and 24 died in the ED (total 61; 0.3%). The inpatient death rate was 0.4%. Suspected seizures represented 0.71% of ED attendances, 89.8% of these arrived by emergency ambulance, 45.4% were admitted and 44.5% of these admissions lasted under 48 hours. CONCLUSIONS This study confirms previously published data from smaller unlinked datasets, validating the linkage method, and provides new data for suspected seizures. There are significant barriers to realising the full potential of data linkage. Collaborative action is needed to create facilitative governance frameworks and improve data quality and analytical capacity.
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Affiliation(s)
- Thomas Hughes-Gooding
- The University of Sheffield Medical School, Sheffield, UK
- Rotherham General Hospitals NHS Trust, Rotherham, UK
| | - Jon M Dickson
- The Academic Unit of Primary Medical Care, The University of Sheffield, Sheffield, UK
| | - Colin O'Keeffe
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Suzanne M Mason
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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Man NWY, Forero R, Ngo H, Mountain D, FitzGerald G, Toloo GS, McCarthy S, Mohsin M, Fatovich DM, Bailey P, Bosley E, Carney R, Lai HMX, Hillman K. Impact of the Four-Hour Rule policy on emergency medical services delays in Australian EDs: a longitudinal cohort study. Emerg Med J 2020; 37:793-800. [PMID: 32669320 DOI: 10.1136/emermed-2019-208958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 05/26/2020] [Accepted: 05/29/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Delayed handover of emergency medical services (EMS) patients to EDs is a major issue with hospital crowding considered a primary cause. We explore the impact of the 4-hour rule (the Policy) in Australia, focusing on ambulance and ED delays. METHODS EMS (ambulance), ED and hospital data of adult patients presenting to 14 EDs from 2002 to 2013 in three jurisdictions were linked. Interrupted time series 'Before-and-After' trend analysis was used for assessing the Policy's impact. Random effects meta-regression analysis was examined for associations between ambulance delays and Policy-associated ED intake, throughput and output changes. RESULTS Before the Policy, the proportion of ED ambulances delayed increased between 1.1% and 1.7% per quarter across jurisdictions. After Policy introduction, Western Australia's increasing trend continued but Queensland decreased by 5.1% per quarter. In New South Wales, ambulance delay decreased 7.1% in the first quarter after Policy introduction. ED intake (triage delay) improved only in New South Wales and Queensland. Each 1% ambulance delay reduction was significantly associated with a 0.91% reduction in triage delay (p=0.014) but not ED length of stay ≤4 hours (p=0.307) or access-block/boarding (p=0.605) suggesting only partial improvement in ambulance delay overall. CONCLUSION The Policy was associated with reduced ambulance delays over time in Queensland and only the immediate period in New South Wales. Associations may be due to local jurisdictional initiatives to improve ambulance performance. Strategies to alleviate ambulance delay may need to focus on the ED intake component. These should be re-examined with longer periods of post-Policy data.
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Affiliation(s)
- Nicola Wing Young Man
- Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Randwick, New South Wales, Australia
| | - Roberto Forero
- Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia .,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Hanh Ngo
- Division of Emergency Medicine, Faculty of Health and Medical Services, University of Western Australia, Perth, Western Australia, Australia
| | - David Mountain
- Division of Emergency Medicine, Faculty of Health and Medical Services, University of Western Australia, Perth, Western Australia, Australia.,Emergency Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Gerard FitzGerald
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Ghasem Sam Toloo
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Sally McCarthy
- Emergency Department, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia
| | - Mohammed Mohsin
- Psychiatry Research and Teaching Unit, Liverpool Hospital, Liverpool, New South Wales, Australia.,School of Psychiatry, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | - Daniel M Fatovich
- Division of Emergency Medicine, Faculty of Health and Medical Services, University of Western Australia, Perth, Western Australia, Australia.,Emergency Medicine, Royal Perth Hospital, Centre for Clinical Research in Emergency Medicine, Perth, Western Australia, Australia
| | - Paul Bailey
- St John Ambulance Western Australia, Perth, Western Australia, Australia
| | - Emma Bosley
- Queensland Ambulance Service, Brisbane, Queensland, Australia
| | - Rosemary Carney
- New South Wales Ambulance Service, Rozelle, New South Wales, Australia
| | - Harry Man Xiong Lai
- New South Wales Ambulance Service, Rozelle, New South Wales, Australia.,Discipline of Psychiatry, University Of Sydney, Sydney, New South Wales, Australia
| | - Ken Hillman
- Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
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Martín-Rodríguez F, López-Izquierdo R, Delgado Benito JF, Sanz-García A, del Pozo Vegas C, Castro Villamor MÁ, Martín-Conty JL, Ortega GJ. Prehospital Point-Of-Care Lactate Increases the Prognostic Accuracy of National Early Warning Score 2 for Early Risk Stratification of Mortality: Results of a Multicenter, Observational Study. J Clin Med 2020; 9:jcm9041156. [PMID: 32325636 PMCID: PMC7231108 DOI: 10.3390/jcm9041156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/12/2020] [Accepted: 04/14/2020] [Indexed: 02/05/2023] Open
Abstract
The objective of this study was to assess whether the use of prehospital lactate (pLA) can increase the prognostic accuracy of the National Early Warning Score 2 (NEWS2) to detect the risk of death within 48 h. A prospective, multicenter study in adults treated consecutively by the emergency medical services (EMS) included six advanced life support (ALS) services and five hospitals. Patients were assigned to one of four groups according to their risk of mortality (low, low-medium, medium, and high), as determined by the NEWS2 score. For each group, the validity of pLA in our cohort was assessed by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. In this study, 3081 participants with a median age of 69 years (Interquartile range (IQR): 54-81) were included. The two-day mortality was 4.4% (137 cases). The scale derived from the implementation of the pLA improved the capacity of the NEWS2 to discriminate low risk of mortality, with an AUC of 0.910 (95% CI: 0.87-0.94; p < 0.001). The risk stratification provided by the NEWS2 can be improved by incorporating pLA measurement to more accurately predict the risk of mortality in patients with low risk.
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Affiliation(s)
- Francisco Martín-Rodríguez
- Advanced Clinical Simulation Center, School of Medicine, Universidad de Valladolid, 47005 Valladolid, Spain; (F.M.-R.); (M.Á.C.V.)
- Advanced Life Support Unit, Emergency Medical Services, 47007 Valladolid, Spain;
| | - Raúl López-Izquierdo
- Emergency Department, Hospital Universitario Rio Hortega, 47012 Valladolid, Spain
- Correspondence: ; Tel.: +34-647-946-325
| | | | - Ancor Sanz-García
- Data Analysis Unit, Health Research Institute, Hospital de la Princesa, 28006 Madrid, Spain; (A.S.-G.); (G.J.O.)
| | - Carlos del Pozo Vegas
- Emergency Department, Hospital Clínico Universitario de Valladolid, 47005 Valladolid, Spain;
| | - Miguel Ángel Castro Villamor
- Advanced Clinical Simulation Center, School of Medicine, Universidad de Valladolid, 47005 Valladolid, Spain; (F.M.-R.); (M.Á.C.V.)
| | - José Luis Martín-Conty
- Faculty of Health Sciences, Universidad de Castilla la Mancha, 45600 Talavera de la Reina, Ciudad Real, Spain;
| | - Guillermo J. Ortega
- Data Analysis Unit, Health Research Institute, Hospital de la Princesa, 28006 Madrid, Spain; (A.S.-G.); (G.J.O.)
- CONICET, C1425FQB Buenos Aires, Argentina
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13
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Crilly J, Johnston AN, Wallis M, O'Dwyer J, Byrnes J, Scuffham P, Zhang P, Bosley E, Chaboyer W, Green D. Improving emergency department transfer for patients arriving by ambulance: A retrospective observational study. Emerg Med Australas 2019; 32:271-280. [PMID: 31867883 PMCID: PMC7155107 DOI: 10.1111/1742-6723.13407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 09/20/2019] [Accepted: 09/21/2019] [Indexed: 11/29/2022]
Abstract
Objective Extended delays in the transfer of patients from ambulance to ED can compromise patient flow. The present study aimed to describe the relationship between the use of an Emergency Department Ambulance Off‐Load Nurse (EDAOLN) role, ED processes of care and cost effectiveness. Methods This was a retrospective observational study over three periods of before (T1), during (T2) and after (T3) the introduction of the EDAOLN role in 2012. Ambulance, ED and cost data were linked and used for analysis. Processes of care measures analysed included: time to be seen by a doctor from ED arrival (primary outcome), ambulance‐ED offload compliance, proportion of patients seen within recommended triage timeframe, ED length of stay (LoS), proportion of patients transferred, admitted or discharged from the ED within 4 h and cost effectiveness. Results A total of 6045 people made 7010 presentations to the ED by ambulance over the study period. Several measures improved significantly between T1 and T2 including offload compliance (T1: 58%; T2: 63%), time to be seen (T1: 31 min; T2: 28 min), ED LoS (T1: 335 min; T2: 306 min), ED LoS <4 h (T1: 31%; T2: 33%). Some measures carried over into T3, albeit to a lesser extent. Post‐hoc analyses showed that outcomes improved most for less urgent patients. The annualised net cost of the EDAOLN (if funded from additional resources) of $130 721 could result in an annualised reduction of approximately 3912 h in waiting time to be seen by a doctor. Conclusion With the EDAOLN role in place, slight outcome improvements in several key ambulance and ED efficiency criteria were noted. During times of ED crowding, the EDAOLN role may be one cost‐effective strategy to consider.
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Affiliation(s)
- Julia Crilly
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Amy Nb Johnston
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Department of Emergency Medicine, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,School of Nursing, Midwifery and Social Work, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Marianne Wallis
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Maroochydore DC, Queensland, Australia
| | - John O'Dwyer
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Australian eHealth Research Centre, Herston, Queensland, Australia
| | - Joshua Byrnes
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,School of Medicine, Griffith University Nathan Campus, Brisbane, Queensland, Australia
| | - Paul Scuffham
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,School of Medicine, Griffith University Nathan Campus, Brisbane, Queensland, Australia
| | - Ping Zhang
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Emma Bosley
- Office of the Commissioner, Queensland Ambulance Service, Department of Health, Brisbane, Queensland, Australia
| | - Wendy Chaboyer
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - David Green
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,School of Medicine, Griffith University Nathan Campus, Brisbane, Queensland, Australia
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14
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Sultan M, Abebe Y, Tsadik AW, Ababa A, Yesus AG, Mould-Millman NK. Trends and barriers of emergency medical service use in Addis Ababa; Ethiopia. BMC Emerg Med 2019; 19:28. [PMID: 30999840 PMCID: PMC6471849 DOI: 10.1186/s12873-019-0242-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 04/02/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The increasing burdens of trauma and time sensitive non-communicable disease in Addis Ababa necessitate a robust emergency medical care system. The objectives of this study were to assess the proportion of patients who used emergency medical services (EMS) and to quantitatively and qualitatively assess barriers to EMS utilization in Addis Ababa. METHODS A cross-sectional quantitative and qualitative study was conducted on patients who visited five selected public hospitals in Addis Ababa with specific emergency conditions. Data were collected by trained nurses using a standardized questionnaire. Descriptive statistics and logistic regression was done on cleaned and coded quantitative data using SPSS version 20. Thematic analysis was performed on the qualitative data. Ethical approval was obtained prior to the study. RESULTS A total of 429 participants completed the survey with a non-response rate of 5.1%. The most common emergency scene was the home (n = 222, 51.8%) followed by road side (n = 159, 37.1%). Only 87(20.3%) patients arrived by ambulance, though a majority (53.4%) of participants recalled at least one access number for an ambulance service and 96.3% stated that ambulances were an important part of the continuum of care for their emergency condition. A higher proportion of participants believed that ambulance transportation is generally safer (n = 341, 78.5%) and faster (n = 298, 69.5%) than emergency transport by taxi or private car. Patients who were non-Amharic speaking had a negative association with arriving by ambulance (P = 0.001, OR 0.47; C.I, 0.31, 0.71). The median acceptable time to get the ambulance (according to respondent's perception) was 16 min but actually perceived ambulance waiting time was 40 min. CONCLUSION EMS utilization in Addis Ababa is relatively low and emergency patients are instead being transported by taxi or private car. Perceived longer ambulance waiting time and language barriers may have contributed for low utilization. Findings of this study suggest an action to improve access by improving ambulance availability while simultaneously enhancing the public's knowledge and perception of EMS in Addis Ababa.
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Affiliation(s)
- Menbeu Sultan
- Department of Emergency Medicine and Critical Care, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
| | - Yonas Abebe
- Department of Emergency Medicine and Critical Care nursing, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Assefu Welde Tsadik
- Ethiopian Federal Ministry of Health, Emergency and Critical Care Directorate, Addis Ababa, Ethiopia
| | - Asmamaw Ababa
- Department of Emergency Medicine and Critical Care, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
| | - Alegnta Gebre Yesus
- Department of Emergency Medicine and Critical Care, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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15
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Are emergency medical services offload delay patients at increased risk of adverse outcomes? CAN J EMERG MED 2019; 21:505-512. [PMID: 30841940 DOI: 10.1017/cem.2018.478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Emergency department (ED) and hospital overcrowding cause offload delays that remove emergency medical services (EMS) crews from service and compromise care delivery. Prolonged ED boarding and delays to inpatient care are associated with increased hospital length of stay (LOS) and patient mortality, but the effects of EMS offload delays have not been well studied. METHODS We used administrative data to study all high-acuity Canadian Triage Acuity Scale 2-3 EMS arrivals to Calgary adult EDs from July 2013 to June 2016. Patients offloaded to a care space within 15 minutes were considered controls, whereas those delayed ≥ 60 minutes were considered "delayed." Propensity matching was used to create comparable control and delayed cohorts. The primary outcome was 7-day mortality. Secondary outcomes included hospital LOS and 30-day mortality. RESULTS Of 162,002 high-acuity arrivals, 70,711 had offload delays 60 minutes. Delayed patients were more likely to be female, older, to have lower triage acuity, to live in dependent living situations, and to arrive on weekdays and day or evening hours. Delayed patients less often required admission and, when admitted, were more likely to go to the hospitalist service. Main outcomes were similar for propensity-matched control and delayed cohorts, although delayed patients experienced longer ED LOS and slightly lower 7-day mortality rates. CONCLUSION In this setting, high-acuity EMS arrivals exposed to offload delays did not have prolonged hospital LOS or higher mortality than comparable patients who received timely access.
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16
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Beltrán Guzmán I, Gil Cuesta J, Trelles M, Jaweed O, Cherestal S, van Loenhout JAF, Guha-Sapir D. Delays in arrival and treatment in emergency departments: Women, children and non-trauma consultations the most at risk in humanitarian settings. PLoS One 2019; 14:e0213362. [PMID: 30835777 PMCID: PMC6400395 DOI: 10.1371/journal.pone.0213362] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/20/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Delays in arrival and treatment at health facilities lead to negative health outcomes. Individual and external factors could be associated with these delays. This study aimed to assess common factors associated with arrival and treatment delays in the emergency departments (ED) of three hospitals in humanitarian settings. METHODOLOGY This was a cross-sectional study based on routine data collected from three MSF-supported hospitals in Afghanistan, Haiti and Sierra Leone. We calculated the proportion of consultations with delay in arrival (>24 hours) and in treatment (based on target time according to triage categories). We used a multinomial logistic regression model (MLR) to analyse the association between age, sex, hospital and diagnosis (trauma and non-trauma) with these delays. RESULTS We included 95,025 consultations. Males represented 65.2%, Delay in arrival was present in 27.8% of cases and delay in treatment in 27.2%. The MLR showed higher risk of delay in arrival for females (OR 1.2, 95% CI 1.2-1.3), children <5 (OR 1.4, 95% CI 1.4-1.5), patients attending to Gondama (OR 30.0, 95% CI 25.6-35.3) and non-trauma cases (OR 4.7, 95% CI 4.4-4.8). A higher risk of delay in treatment was observed for females (OR 1.1, 95% CI 1.0-1.1), children <5 (OR 2.0, 95% CI 1.9-2.1), patients attending to Martissant (OR 14.6, 95% CI 13.9-15.4) and non-trauma cases (OR 1.6, 95% CI 1.5-1.7). CONCLUSIONS Women, children <5 and non-trauma cases suffered most from delays. These delays could relate to educational and cultural barriers, and severity perception of the disease. Treatment delay could be due to insufficient resources with consequent overcrowding, and severity perception from medical staff for non-trauma patients. Extended community outreach, health promotion and support to community health workers could improve emergency care in humanitarian settings.
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Affiliation(s)
- Isabel Beltrán Guzmán
- Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
- Operational Centre Geneva, Médecins Sans Frontières, Geneva, Switzerland
| | - Julita Gil Cuesta
- Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium
| | - Miguel Trelles
- Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium
| | - Omar Jaweed
- Mission Afghanistan, Médecins Sans Frontières, Kunduz, Afghanistan
| | - Sophia Cherestal
- Mission Haiti, Operational Centre Brussels, Médecins Sans Frontières, Port-au-Prince, Haiti
| | - Joris Adriaan Frank van Loenhout
- Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Debarati Guha-Sapir
- Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
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18
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Bell A, Toloo GS, Crilly J, Burke J, Williams G, McCann B, FitzGerald G. Emergency department models of care in Queensland: a multisite cross-sectional study. AUST HEALTH REV 2019; 43:363-370. [DOI: 10.1071/ah17233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/26/2018] [Indexed: 11/23/2022]
Abstract
Objective
The acuity and number of presentations being made to emergency departments (EDs) is increasing. In an effort to safely and efficiently manage this increase and optimise patient outcomes, innovative models of care (MOC) have been implemented. What is not clear is how these MOC reflect the needs of patients or relate to each other or to ED performance. The aim of this study was to describe ED MOC in Queensland, Australia.
Methods
Situated within a larger mixed-methods study, the present study was a cross-sectional study. In early 2015, leaders (medical directors and nurse managers) from public hospital EDs in Queensland were invited to complete a survey detailing ED activity, staffing profiles, treatment space, MOC and National Emergency Access Target (NEAT) performance. Routinely collected ED information system data was also used.
Results
Twenty of the 27 EDs invited participated in the study (response rate 74%). An extensive array of MOC were identified that were categorised into those that facilitate input, throughput and output from the ED. There was no consistent evidence as to the relative effectiveness of these MOC in achieving ED performance benchmarks, such as NEAT performance.
Conclusion
There is considerable variability in the MOC used throughout EDs in Queensland. A more complete analysis of the relative effectiveness of different MOC either in isolation or as part of a comprehensive approach would help inform more consistent MOC in Queensland EDs.
What is known about the topic?
MOC in any given ED are implemented in response to factors such as the geographical location of the hospital, hospital-specific characteristics and service profile, staffing profile and patient demographic profile. In the era of time-based targets, they may also serve to address a particular aspect of flow in the face of rising ED demand. Although many of the MOC attempt to deal with flow in a linear fashion, target specific phases of the ED journey or address particular patient cohorts, what is clear is that not all EDs are shaped and formed the same.
What does this paper add?
The study provides a comprehensive description of the varied models of care operating within Queensland public hospital EDs and how they relate to ED performance. A basic taxonomy of contemporary ED MOC is necessary to allow comparison between departments and inform decisions regarding safety, efficiency and cost-effectiveness.
What are the implications to practitioners?
A contemporary understanding of the presence and profile of ED MOC that currently exist within a network of hospitals and health services is important for managers, clinicians and patients to inform decision-making regarding the safety, clinical effectiveness and cost-effectiveness of these models. This understanding can also inform where and how further improvements in care delivery can progress.
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Li M, Vanberkel P, Carter AJE. A review on ambulance offload delay literature. Health Care Manag Sci 2018; 22:658-675. [PMID: 29982911 DOI: 10.1007/s10729-018-9450-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 06/18/2018] [Indexed: 11/25/2022]
Abstract
Ambulance offload delay (AOD) occurs when care of incoming ambulance patients cannot be transferred immediately from paramedics to staff in a hospital emergency department (ED). This is typically due to emergency department congestion. This problem has become a significant concern for many health care providers and has attracted the attention of many researchers and practitioners. This article reviews literature which addresses the ambulance offload delay problem. The review is organized by the following topics: improved understanding and assessment of the problem, analysis of the root causes and impacts of the problem, and development and evaluation of interventions. The review found that many researchers have investigated areas of emergency department crowding and ambulance diversion; however, research focused solely on the ambulance offload delay problem is limited. Of the 137 articles reviewed, 28 articles were identified which studied the causes of ambulance offload delay, 14 articles studied its effects, and 89 articles studied proposed solutions (of which, 58 articles studied ambulance diversion and 31 articles studied other interventions). A common theme found throughout the reviewed articles was that this problem includes clinical, operational, and administrative perspectives, and therefore must be addressed in a system-wide manner to be mitigated. The most common intervention type was ambulance diversion. Yet, it yields controversial results. A number of recommendations are made with respect to future research in this area. These include conducting system-wide mitigation intervention, addressing root causes of ED crowding and access block, and providing more operations research models to evaluate AOD mitigation interventions prior implementations. In addition, measurements of AOD should be improved to assess the size and magnitude of this problem more accurately.
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Affiliation(s)
- Mengyu Li
- Faculty of Engineering, Department of Industrial Engineering, Dalhousie University, Halifax, NS, Canada.
| | - Peter Vanberkel
- Faculty of Engineering, Department of Industrial Engineering, Dalhousie University, Halifax, NS, Canada
| | - Alix J E Carter
- Department of Emergency Medicine, Division of EMS, Dalhousie University, Halifax, NS, Canada
- Emergency Health Services, Dartmouth, NS, Canada
- Nova Scotia Health Authority, Sydney, NS, Canada
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20
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The impact of an Emergency Department ambulance offload nurse role: A retrospective comparative study. Int Emerg Nurs 2017; 32:39-44. [DOI: 10.1016/j.ienj.2016.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 12/11/2016] [Accepted: 12/21/2016] [Indexed: 11/22/2022]
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21
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‘Care in a chair’ – The impact of an overcrowded Emergency Department on the time to treatment and length of stay of self-presenting patients with abdominal pain. Int Emerg Nurs 2016; 29:9-14. [DOI: 10.1016/j.ienj.2016.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 08/01/2016] [Accepted: 08/14/2016] [Indexed: 11/20/2022]
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Perry M, Carter D. The ethics of ambulance ramping. Emerg Med Australas 2016; 29:116-118. [PMID: 27400802 DOI: 10.1111/1742-6723.12625] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 05/03/2016] [Indexed: 11/28/2022]
Abstract
Ramping is the practice of requiring paramedics to continue to care for patients rather than hand over clinical responsibility to the ED. It arose as an alternative to admitting patients to EDs that are deemed to be already operating at or beyond capacity. This paper analyses the ethics of ramping. Ramping has been embraced by some ED practitioners and policymakers as a solution to the problem of ED patients suffering increased risks of harm as a result of waiting times within ED. However, this perspective fails to adequately consider the implications, especially the opportunity cost of requiring paramedics to remain at the hospital rather than make themselves available for other patients. From this perspective, ramping negatively impacts the wider provision of emergency medical services, with potentially serious consequences for people's health. Advocates of ramping must consider people in the community who require a medical emergency response.
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Affiliation(s)
- Matthew Perry
- Paramedic Emergency Care, Department of Applied Health and Professional Development, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Drew Carter
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
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Dinh MM, Muecke S, Berendsen Russell S, Chalkley D, Bein KJ, Muscatello D, Nagaraj G, Paoloni R, Ivers R. Demand for Emergency Services Trends in New South Wales Years 2010–2014 (DESTINY): Age and Clinical Factors Associated with Ambulance Transportation to Emergency Departments. PREHOSP EMERG CARE 2016; 20:776-782. [DOI: 10.1080/10903127.2016.1182603] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Aldridge ES, Rogers IR, Bailey PM, Rogers JR. Emergency department 'undercrowding' is associated with decreased waiting times. Emerg Med Australas 2016; 28:268-72. [PMID: 26995265 DOI: 10.1111/1742-6723.12569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 01/19/2016] [Accepted: 01/31/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the effect of a sudden and sustained decrease in patient presentations on waiting times and other measures of workload and flow following the opening of a large, greenfields ED adjacent to our own. METHOD A descriptive study involving all patients presenting to a private urban district hospital ED for two 60 day periods, immediately before and after the opening of the tertiary hospital ED. Changes in median waiting time, case-mix distribution, method of arrival, total admissions and total waiting time were compared pre-opening and post-opening. Non-normally distributed variables were analysed using Mann-Whitney U-tests. Categorical variables were compared using χ(2) analyses. RESULTS Patient presentations decreased by 28% with a parallel decline in median waiting time of 15 min (from 26 to 11 min) (P < 0.001). Total waiting time was approximately 29 h less per day in the post-opening period. Patient urgency by triage category did not change significantly (P = 0.316), whereas the proportion of presentations by ambulance decreased 15.9% (P = 0.048) and admission rate increased from 29.1% to 32.6% (P = 0.002). CONCLUSIONS Patient presentation numbers are strongly associated with and likely impact on median waiting time. Understanding that controlling demand can lead to significant benefits in patient processing, flow and overall patient perceived level of care and satisfaction is relevant to any discussion on ED overcrowding and the deleterious effects of access block.
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Affiliation(s)
- Emogene S Aldridge
- Emergency Department, St John of God Murdoch Hospital, Perth, Western Australia, Australia
| | - Ian R Rogers
- Emergency Department, St John of God Murdoch Hospital, Perth, Western Australia, Australia.,University of Notre Dame Australia, Perth, Western Australia, Australia
| | - Paul M Bailey
- Emergency Department, St John of God Murdoch Hospital, Perth, Western Australia, Australia
| | - Jeremy R Rogers
- Emergency Department, St John of God Murdoch Hospital, Perth, Western Australia, Australia
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Zia N, Shahzad H, Baqir S, Shaukat S, Ahmad H, Robinson C, Hyder AA, Razzak J. Ambulance use in Pakistan: an analysis of surveillance data from emergency departments in Pakistan. BMC Emerg Med 2015; 15 Suppl 2:S9. [PMID: 26689242 PMCID: PMC4682417 DOI: 10.1186/1471-227x-15-s2-s9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background The utilization of ambulances in low- and middle-income countries is limited. The aim of this study was to ascertain frequency of ambulance use and characteristics of patients brought into emergency departments (EDs) through ambulance and non-ambulance modes of transportation. Methods The Pakistan National Emergency Departments Surveillance (Pak-NEDS) was a pilot active surveillance conducted in seven major tertiary-care EDs in six main cities of Pakistan between November 2010 and March 2011. Univariate and multivariate logistic regression was performed to investigate the factors associated with ambulance use. Results Out of 274,436 patients enrolled in Pak-NEDS, the mode of arrival to the ED was documented for 94. 9% (n = 260,378) patients, of which 4.1% (n = 10,546) came to EDs via ambulances. The mean age of patients in the ambulance group was significantly higher compared to the mean age of the non-ambulance group (38 ± 18.4 years versus 32.8 ± 14.9 years, p-value < 0.001). The most common presenting complaint in the ambulance group was head injury (12%) while among non-ambulance users it was fever (12%). Patients of all age groups were less likely to use an ambulance compared to those >45 years of age (p-value < 0.001) adjusted for gender, cities, hospital type, presenting complaint group and disposition. The adjusted odds ratio of utilizing ambulances for those with injuries was 3.5 times higher than those with non-injury complaints (p-value < 0.001). Patients brought to the ED by ambulance were 7.2 times more likely to die in the ED than non-ambulance patients after adjustment for other variables in the model. Conclusion Utilization of ambulances is very low in Pakistan. Ambulance use was found to be more among the elderly and those presenting with injuries. Patients presenting via ambulances were more likely to die in the ED.
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