Dataset Information

Ambulance diversions following public hospital emergency department closures.

ABSTRACT:

Objective

To examine whether hospitals are more likely to temporarily close their emergency departments (EDs) to ambulances (through ambulance diversions) if neighboring diverting hospitals are public vs private.

Data sources/study setting

Ambulance diversion logs for California hospitals, discharge data, and hospital characteristics data from California's Office of Statewide Health Planning and Development and the American Hospital Association (2007).

Study design

We match public and private (nonprofit or for-profit) hospitals by distance and size. We use random-effects models examining diversion probability and timing of private hospitals following diversions by neighboring public vs matched private hospitals.

Data collection/extraction methods

N/A.

Principal findings

Hospitals are 3.6 percent more likely to declare diversions if neighboring diverting hospitals are public vs private (P < 0.001). Hospitals declaring diversions have lower ED occupancy (P < 0.001) after neighboring public (vs private) hospitals divert. Hospitals have 4.2 percent shorter diversions if neighboring diverting hospitals are public vs private (P < 0.001). When the neighboring hospital ends its diversion first, hospitals terminate diversions 4.2 percent sooner if the neighboring hospital is public vs private (P = 0.022).

Conclusions

Sample hospitals respond differently to diversions by neighboring public (vs private) hospitals, suggesting that these hospitals might be strategically declaring ambulance diversions to avoid treating low-paying patients served by public hospitals.

SUBMITTER: Hsuan C

PROVIDER: S-EPMC6606538 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Ambulance diversions following public hospital emergency department closures.

Hsuan Charleen C Hsia Renee Y RY Horwitz Jill R JR Ponce Ninez A NA Rice Thomas T Needleman Jack J

Health services research 20190402 4

<h4>Objective</h4>To examine whether hospitals are more likely to temporarily close their emergency departments (EDs) to ambulances (through ambulance diversions) if neighboring diverting hospitals are public vs private.<h4>Data sources/study setting</h4>Ambulance diversion logs for California hospitals, discharge data, and hospital characteristics data from California's Office of Statewide Health Planning and Development and the American Hospital Association (2007).<h4>Study design</h4>We match ...[more]

PMID: 30941753

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Project description:Clinical handovers of patient care among healthcare professionals is vulnerable to the loss of important clinical information. A verbal report is typically provided by paramedics and documented by emergency department (ED) triage nurses. Paramedics subsequently complete a patient care report which is submitted electronically. This emergency medical system (EMS) patient care report often contains details of paramedic assessment and management that is not all captured in the nursing triage note. EMS patient care reports are often unavailable for review by emergency physicians and nurses. Two processes occur in the distribution of EMS patient care reports. The first is an external process to the ED that is influenced by the prehospital emergency medical system and results in the report being faxed to the ED. The second process is internal to the ED that requires clerical staff to distribute the fax report to accompany patient charts. A baseline audit measured the percentage of EMS patient care reports that were available to emergency physicians at the time of initial patient assessments and showed a wide variation in the availability of EMS reports. Also measured were the time intervals from patient transfer from EMS to ED stretcher until the EMS report was received by fax (external process measure) and the time from receiving the EMS fax report until distribution to patient chart (internal process measure). These baseline measures showed a wide variation in the time it takes to receive the EMS reports by fax and to distribute reports. Improvement strategies consisted of: 1. Educating ED clerical staff about the importance of EMS reports 2. Implementing a new process to minimize ED clerical staff handling of EMS reports for nonactive ED patients 3. Elimination of the automatic retrieval of old hospital charts and their distribution for ED patients 4. Introduction of an electronic dashboard for patients arriving by ambulance to facilitate more efficient distribution of EMS reports. Implementation of change strategies did not result in a significant improvement in the percentage of EMS reports available to emergency physicians at the time of initial patient assessment. However, tracking both external and internal processes that influence EMS report availability showed the internal process time from fax report receipt to distribution significantly improved. This improvement reflected the change strategies that were all directed at improving the internal process. EMS patient care reports are more efficiently processed and distributed in the ED due to change strategies implemented that targeted the ED's internal process of EMS report distribution. The external process responsible for transmitting EMS reports to the ED is the limiting factor that prevents consistent timely access of EMS reports by emergency physicians and will require dedicated improvement strategies.

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Project description:ObjectivesAmbulance clinicians use prealert calls to advise emergency departments (ED) of the arrival of patients requiring immediate review or intervention. Consistency of prealert practice is important in ensuring appropriate ED response to prealert calls. We used routine data to describe prealert practice and explore factors affecting variation in practice.Design and settingWe undertook a retrospective observational study in three UK ambulance services using a linked dataset incorporating 12 months' ambulance patient records, ambulance clinician data and emergency call data.Outcome measuresWe used least absolute shrinkage and selection operator regression to identify candidate variables for multivariate logistic regression models to predict variation in prealert use, analysing clinician factors (role, experience, qualification, time of prealert during shift), patient factors (National Early Warning Score version 2, clinical working impression, age, sex) and hospital factors (receiving ED, ED handover delay status).ResultsFrom the dataset of 1 363 274 patients conveyed to ED, 142 795 (10.5%) were prealerted, of whom 42 362 (30%) were for conditions with clear prealert pathways (eg, sepsis, stroke, ST-elevation myocardial infarction, major trauma). Prealert rates varied across and within different ambulance services. Casemix (illness acuity score, clinical diagnostic impression) was the strongest predictor of prealert use, but male patient sex, clinician role, receiving hospital and hospital turnaround delay at receiving hospitals were also statistically significant predictors, after adjusting for casemix. There was no evidence that prealert rates are higher during the final hour of shift.ConclusionsPrealert decisions are influenced by factors other than illness acuity and clinical diagnostic impression alone. Variation in prealert practice suggests that procedures and processes for prealerting may lack clarity and improved prealert protocols may be required. Research is required to understand whether our findings are reproducible elsewhere and why non-clinical factors (eg, patient gender) may influence prealert practice.

Dataset Information

Ambulance diversions following public hospital emergency department closures.

Objective

Data sources/study setting

Study design

Data collection/extraction methods

Principal findings

Conclusions

Publications

Ambulance diversions following public hospital emergency department closures.

Similar Datasets

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