1
|
Valentin JB, Hansen NH, Behrndtz AB, Væggemose U, Gude MF. Effect of urgency level on prehospital emergency transport times: a natural experiment. Intern Emerg Med 2024; 19:445-453. [PMID: 38123903 PMCID: PMC10954969 DOI: 10.1007/s11739-023-03501-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
Accurate estimation of ambulance transport time from the scene of incident to arrival at the emergency department (ED) is important for effective resource management and emergency care system planning. Further, differences in transport times between different urgency levels highlight the benefits of ambulance transports with highest urgency level in a setting where ambulances are allowed to not follow standard traffic rules. The objective of the study is to compare ambulance urgency level on the differences in estimates of ambulance transport times generated by Google Maps and the observed transport times in a prehospital setting where emergency vehicles have their own traffic laws. The study was designed as a natural experiment and register study. Ambulance transports dispatched with different levels of urgency (Level A and B) were included in the Central Denmark Region (a mixed urban and rural area) from March 10 to June 11, 2021. Ambulance transports for highest urgency level were compared to lowest urgency level with Google Maps estimated transport times as reference. We analyzed 1981 highest urgency level and 8.958 lowest urgency level ambulance transports. Google Maps significantly overestimated the duration of transports operating at highest level of urgency (Level A) by 1.9 min/10 km (95% CI 1.8; 2.0) in average and 4.8 min/10 km (95% CI 3.9; 5.6) for the first driven 10 km. Contrary, Google Maps significantly underestimated the duration of transports operating at lowest level of urgency (Level B) by -1.8 min/10 km (95% CI -2.1; -1.5) in average and -4.4 min/10 km (95% CI -5.4; -3.5) for the first driven 10 km. Google Maps systematically overestimates transport times of ambulance transports driven with Level A, the highest level of urgency in a setting where ambulances are allowed to not follow standard traffic rules. The results highlight the benefit of using urgency Level A and provide valuable information for emergency care management.
Collapse
Affiliation(s)
- Jan Brink Valentin
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Nanna Høgh Hansen
- Department of Research and Development, Prehospital Emergency Medical Services, Central Denmark Region, Denmark
| | | | - Ulla Væggemose
- Department of Research and Development, Prehospital Emergency Medical Services, Central Denmark Region, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Martin Faurholdt Gude
- Department of Research and Development, Prehospital Emergency Medical Services, Central Denmark Region, Denmark
| |
Collapse
|
2
|
Mériade L, Rochette C. Integrated care pathway for breast cancer: A relational and geographical approach. Soc Sci Med 2020; 270:113658. [PMID: 33421916 DOI: 10.1016/j.socscimed.2020.113658] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/07/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
This paper examines how to apply a spatial approach (relational and geographical) to care pathways for their better integration within their territories. Based on the case study of a senology department of a French Cancer Diagnosis, Treatment and Research Centre, we apply a mixed research methodology using qualitative data (synthesis documents, meeting minutes, in-depth interviews) and quantitative data relating to the mobility and geographical location of a cohort of 1798 patients treated in this centre. Our results show the inseparable nature of the relational dimension and the geographical approach to move towards greater integration of breast cancer care pathways. This inseparability is constructed from the proposal of a method for mapping the integrated care pathways in their territories. This method, applied to our case study, allows us to identify four main categories of pathways for the cohort of patients studied.
Collapse
Affiliation(s)
- Laurent Mériade
- CleRMa - Research Chair "Health and Territories" - IAE School of Management - Clermont Auvergne University, 11, boulevard Charles de Gaulle, 63000, Clermont-Ferrand, France.
| | - Corinne Rochette
- CleRMa - Research Chair "Health and Territories" - IAE School of Management - Clermont Auvergne University, 11, boulevard Charles de Gaulle, 63000, Clermont-Ferrand, France.
| |
Collapse
|
3
|
Salih T, Martin P, Poulton T, Oliver CM, Bassett MG, Moonesinghe SR. Distance travelled to hospital for emergency laparotomy and the effect of travel time on mortality: cohort study. BMJ Qual Saf 2020; 30:bmjqs-2019-010747. [PMID: 32576606 PMCID: PMC8070618 DOI: 10.1136/bmjqs-2019-010747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/22/2020] [Accepted: 05/25/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To evaluate whether distance and estimated travel time to hospital for patients undergoing emergency laparotomy is associated with postoperative mortality. DESIGN National cohort study using data from the National Emergency Laparotomy Audit. SETTING 171 National Health Service hospitals in England and Wales. PARTICIPANTS 22 772 adult patients undergoing emergency surgery on the gastrointestinal tract between 2013 and 2016. MAIN OUTCOME MEASURES Mortality from any cause and in any place at 30 and 90 days after surgery. RESULTS Median on-road distance between home and hospital was 8.4 km (IQR 4.7-16.7 km) with a median estimated travel time of 16 min. Median time from hospital admission to operating theatre was 12.7 hours. Older patients live on average further from hospital and patients from areas of increased socioeconomic deprivation live on average less far away.We included estimated travel time as a continuous variable in multilevel logistic regression models adjusting for important confounders and found no evidence for an association with 30-day mortality (OR per 10 min of travel time=1.02, 95% CI 0.97 to 1.06, p=0.512) or 90-day mortality (OR 1.02, 95 % CI 0.97 to 1.06, p=0.472).The results were similar when we limited our analysis to the subgroup of 5386 patients undergoing the most urgent surgery. 30-day mortality: OR=1.02 (95% CI 0.95 to 1.10, p=0.574) and 90-day mortality: OR=1.01 (95% CI 0.94 to 1.08, p=0.858). CONCLUSIONS In the UK NHS, estimated travel time between home and hospital was not a primary determinant of short-term mortality following emergency gastrointestinal surgery.
Collapse
Affiliation(s)
- Tom Salih
- Department of Anaesthesia, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, Department for Targeted Intervention, Surgical Outcomes Research Centre, Centre for Perioperative Medicine, University College London, London, UK
| | - Peter Martin
- Department of Applied Heath Research, University College London, London, UK
| | - Tom Poulton
- Health Services Research Centre, National Institute for Academic Anaesthesia, London, UK
| | - Charles M Oliver
- Department of Anaesthesia, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, Department for Targeted Intervention, Surgical Outcomes Research Centre, Centre for Perioperative Medicine, University College London, London, UK
| | - Mike G Bassett
- Department of Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
| | - S Ramani Moonesinghe
- Division of Surgery and Interventional Science, Department for Targeted Intervention, Surgical Outcomes Research Centre, Centre for Perioperative Medicine, University College London, London, UK
- Health Services Research Centre, National Institute for Academic Anaesthesia, London, UK
| |
Collapse
|
4
|
O'Mahony E, Ní Shé É, Bailey J, Mannan H, McAuliffe E, Ryan J, Cronin J, Cooney MT. Using geographic information systems to map older people's emergency department attendance for future health planning. Emerg Med J 2019; 36:748-753. [PMID: 31678931 PMCID: PMC6900225 DOI: 10.1136/emermed-2018-207952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/02/2019] [Accepted: 10/07/2019] [Indexed: 11/07/2022]
Abstract
Objectives This study aimed to assess the pattern of use of EDs, factors contributing to the visits, geographical distribution and outcomes in people aged 65 years or older to a large hospital in Dublin. Methods A retrospective analysis of 2 years of data from an urban university teaching hospital ED in the southern part of Dublin was reviewed for the period 2014–2015 (n=103 022) to capture the records of attenders. All ED presentations by individuals 65 years and older were extracted for analysis. Address-matched records were analysed using QGIS, a geographic information systems (GIS) analysis and visualisation tool to determine straight-line distances travelled to the ED by age. Results Of the 49 538 non-duplicate presentations in the main database, 49.9% of the total are women and 49.1% are men. A subset comprised of 40 801 had address-matched records. When mapped, the data showed a distinct clustering of addresses around the hospital site but this clustering shows different patterns based on age cohort. Average distances travelled to ED are shorter for people 65 and older compared with younger patients. Average distances travelled for those aged 65–74 was 21 km (n=4177 presentations); for the age group 75–84, 18 km (n=2518 presentations) and 13 km for those aged 85 and older (n=2104 presentations). This is validated by statistical tests on the clustered data. Self-referral rates of about 60% were recorded for each age group, although this varied slightly, not significantly, with age. Conclusions Health planning at a regional level should account for the significant number of older patients attending EDs. The use of GIS for health planning in particular can assist hospitals to improve their understanding of the origin of the cohort of older ED patients.
Collapse
Affiliation(s)
- Eoin O'Mahony
- The School of Geography, University College Dublin, Dublin, Ireland
| | - Éidín Ní Shé
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Jade Bailey
- School of Medicine, Health Sciences Centre, University College Dublin, University College Dublin, Dublin, Ireland
| | - Hasheem Mannan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Eilish McAuliffe
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - John Ryan
- University College Dublin School of Medicine and Medical Science, Dublin, Ireland.,Department of Emergency Medicine, St Vincent's University Hospital, Dublin, Ireland
| | - John Cronin
- Department of Emergency Medicine, St Vincent's University Hospital, Dublin, Ireland
| | - Marie Therese Cooney
- Department of Emergency Medicine, St Vincent's University Hospital, Dublin, Ireland
| |
Collapse
|
5
|
Vasilyeva K, Widener MJ, Galvagno SM, Ginsberg Z. Spatial methods for evaluating critical care and trauma transport: A scoping review. J Crit Care 2017; 43:265-270. [PMID: 28950247 DOI: 10.1016/j.jcrc.2017.08.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 08/21/2017] [Accepted: 08/29/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE The objective of this scoping review is to inform future applications of spatial research regarding transportation of critically ill patients. We hypothesized that this review would reveal gaps and limitations in the current research regarding use of spatial methods for critical care and trauma transport research. MATERIALS AND METHODS Four online databases, Ovid Medline, PubMed, Embase and Scopus, were searched. Studies were selected if they used geospatial methods to analyze a patient transports dataset. 12 studies were included in this review. RESULTS Majority of the studies employed spatial methods only to calculate travel time or distance even though methods and tools for more complex spatial analyses are widely available. Half of the studies were found to focus on hospital bypass, 2 studies focused on transportation (air or ground) mode selection, 2 studies compared predicted versus actual travel times, and 2 studies used spatial modeling to understand spatial variation in travel times. CONCLUSIONS There is a gap between the availability of spatial tools and their usage for analyzing and improving medical transportation. The adoption of geospatially guided transport decisions can meaningfully impact healthcare expenditures, especially in healthcare systems looking to strategically control expenditures with minimum impact on patient outcomes.
Collapse
Affiliation(s)
- Katia Vasilyeva
- Department of Geography and Planning, University of Toronto St. George, 100 St. George St, Toronto, ON M5S 3G3, Canada
| | - Michael J Widener
- Department of Geography and Planning, University of Toronto St. George, 100 St. George St, Toronto, ON M5S 3G3, Canada.
| | - Samuel M Galvagno
- Department of Anesthesiology and the Program in Trauma, R Adams Cowley Shock Trauma Center University of Maryland School of Medicine, 655 W Baltimore S, Baltimore, MD 21201, USA
| | - Zachary Ginsberg
- Kettering Medical Center, Departments of Emergency Medicine & Critical Care, 3535 Southern Blvd, Kettering, OH 45429, USA
| |
Collapse
|
6
|
Lam SSW, Nguyen FNHL, Ng YY, Lee VPX, Wong TH, Fook-Chong SMC, Ong MEH. Factors affecting the ambulance response times of trauma incidents in Singapore. ACCIDENT; ANALYSIS AND PREVENTION 2015; 82:27-35. [PMID: 26026970 DOI: 10.1016/j.aap.2015.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/07/2015] [Accepted: 05/07/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Time to definitive care is important for trauma outcomes, thus many emergency medical services (EMS) systems in the world adopt response times of ambulances as a key performance indicator. The objective of this study is to examine the underlying risk factors that can affect ambulance response times (ART) for trauma incidents, so as to derive interventional measures that can improve the ART. MATERIAL AND METHODS This was a retrospective study based on two years of trauma data obtained from the national EMS operations centre of Singapore. Trauma patients served by the national EMS provider over the period from 1 January 2011 till 31 December 2012 were included. ART was categorized into "Short" (<4min), "Intermediate" (4-8min) and "Long" (>8min) response times. A modelling framework which leveraged on both multinomial logistic (MNL) regression models and Bayesian networks was proposed for the identification of main and interaction effects. RESULTS Amongst the process-related risk factors, weather, traffic and place of incident were found to be significant. The traffic conditions on the roads were found to have the largest effect-the odds ratio (OR) of "Long" ART in heavy traffic condition was 12.98 (95% CI: 10.66-15.79) times higher than that under light traffic conditions. In addition, the ORs of "Long ART" under "Heavy Rain" condition were significantly higher (OR 1.58, 95% CI: 1.26-1.97) than calls responded under "Fine" weather. After accounting for confounders, the ORs of "Long" ART for trauma incidents at "Home" or "Commercial" locations were also significantly higher than that for "Road" incidents. CONCLUSION Traffic, weather and the place of incident were found to be significant in affecting the ART. The evaluation of factors affecting the ART enables the development of effective interventions for reducing the ART.
Collapse
Affiliation(s)
- Sean Shao Wei Lam
- Health Services Research and Biostatistics Unit, Division of Research, Singapore General Hospital, 226 Outram Road, Singapore 169039, Singapore.
| | - Francis Ngoc Hoang Long Nguyen
- Health Services Research and Biostatistics Unit, Division of Research, Singapore General Hospital, 226 Outram Road, Singapore 169039, Singapore.
| | - Yih Yng Ng
- Medical Department, Singapore Civil Defence Force, 91 Ubi Ave 4, Singapore 408827, Singapore.
| | - Vanessa Pei-Xuan Lee
- Health Services Research and Biostatistics Unit, Division of Research, Singapore General Hospital, 226 Outram Road, Singapore 169039, Singapore.
| | - Ting Hway Wong
- Department of General Surgery, Singapore General Hospital; Health Services Research and Biostatistics Unit, Division of Research, Singapore General Hospital, 226 Outram Road, Singapore 169039, Singapore.
| | - Stephanie Man Chung Fook-Chong
- Health Services Research and Biostatistics Unit, Division of Research, Singapore General Hospital, 226 Outram Road, Singapore 169039, Singapore.
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital; Health Services Research and Biostatistics Unit, Division of Research, Singapore General Hospital; Health Services and Systems Research, Duke-NUS Graduate Medical School, 226 Outram Road, Singapore 169039, Singapore.
| |
Collapse
|