Is There an Association Between Emergency Department Overcrowding and Emergency Medical Services Redirection?

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine Pub Date : 2025-03-01 DOI:10.1016/j.jemermed.2024.09.011

Kurien Mathews MD, Mukund Mohan MD, Paul Barbara MD, Arsalan Shawl DO, Norman Ng DO, Joseph Basile MD, Barry Hahn MD, Amin Mohamadi MD

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引用次数: 0

Abstract

Background

Emergency Medical Systems (EMS) has developed policies to manage patient flow. In New York City, these practices include both diversion and redirection. Currently, gaps in the literature exist regarding the correlation between emergency department (ED) operational metrics and EMS redirection triggers.

Objectives

This study analyzes the relationship between ED operational metrics and EMS redirection practices.

Methods

This single-center retrospective cohort analysis analyzed EMS patient transports from April 2021 to May 2022. Data on EMS redirection was obtained from Fire Department of New York (FDNY) notifications, and ED operational metrics were collected from the hospital's data repository. Metrics included ED length of stay, admission rates, and times from door-to-triage and door-to-room.

Results

During the study, 93,783 patient visits were recorded, with 22,734 (24%) transported by EMS. Redirection was activated on 250 days, predominantly on Mondays. A slight association was found between overall ED volume and redirection occurrences (OR 1.02), but no significant correlations were identified with other specific ED operational metrics.

Conclusions

Our findings indicate no substantial correlation between these practices and ED operational metrics. These results suggest a need for a paradigm shift toward more objective, data-driven measures to inform EMS redirection, ensuring decisions are grounded in the ED's actual operational capacity.

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急诊科过度拥挤与急诊医疗服务重定向之间是否存在关联？

背景：紧急医疗系统（EMS）已经制定了管理病人流量的政策。在纽约市，这些做法包括转移和重新定向。目前，关于急诊科（ED）操作指标与EMS重定向触发器之间的相关性，文献存在空白。目的：本研究分析了ED运营指标与EMS重定向实践之间的关系。方法：该单中心回顾性队列分析分析了2021年4月至2022年5月EMS患者转运情况。EMS重定向的数据来自纽约消防局（FDNY）的通知，ED的操作指标来自医院的数据存储库。指标包括急诊科的住院时间、入院率、从门到分诊和门到房间的时间。结果：在研究期间，记录了93783例患者就诊，其中22734例（24%）通过EMS运送。重定向在250天内被激活，主要是在周一。总体ED体积与重定向发生率之间存在轻微关联（OR 1.02），但与其他特定ED操作指标没有显著相关性。结论：我们的研究结果表明，这些实践与ED操作指标之间没有实质性的相关性。这些结果表明，需要向更客观、数据驱动的措施转变范式，以指导EMS重定向，确保决策基于ED的实际运营能力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Emergency Medicine 医学-急救医学

CiteScore

2.40

自引率

6.70%

发文量

339

审稿时长

2-4 weeks

期刊介绍： The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine