Abstract：
Guidelines recommend emergency medical services (EMS) patients to be transported to the nearest appropriate emergency department (ED). Our objective was to estimate the prevalence of EMS transport to an ED other than the nearest ED (\"potential bypassing\").
Illinois Prehospital Patient Care Report Data of EMS transports (July 2019 to December 2019).
We identified all EMS ground transports with an advanced life-support (ALS) paramedic to an ED for patients aged 21 years and older. Using street address of incident location, we performed geocoding and driving route analyses and obtained estimated driving distance and time to the destination ED and alternative EDs.
Our main outcomes were dichotomous indicators of potential bypassing of the nearest ED based on distance and time. As secondary outcomes we examined potential bypassing indicators based on excess driving distance and time.
We used Poisson regression models to obtain adjusted relative rates of potential bypassing indicators by acuity level, primary impression, patient demographics and geographic characteristics.
Our study cohort of 361,051 EMS transports consisted of 5.8% critical, 37.2% emergent and 57.0% low acuity cases transported to 222 EDs. The observed rate of potential bypassing was approximately 34% of cases for each acuity level. Treating the cardiovascular primary impression code group as the reference case, we found small to no differences in potential bypassing rates across other primary impression code groups of all acuity levels, with the exception of critical acuity trauma cases for which potential bypassing rate was 64% higher (incidence rate ratio = 1.64, 95% confidence interval, 1.54-1.74). Compared to zip codes with one ED within a 5-mile vicinity, potential bypassing was higher in areas with no ED or multiple EDs within a 5-mile vicinity.
Approximately one-third of EMS transports potentially bypassed the nearest ED. EMS transport destination may be motivated by factors other than proximity.
Illinois Prehospital Patient Care Report Data of EMS transports (July 2019 to December 2019).
We identified all EMS ground transports with an advanced life-support (ALS) paramedic to an ED for patients aged 21 years and older. Using street address of incident location, we performed geocoding and driving route analyses and obtained estimated driving distance and time to the destination ED and alternative EDs.
Our main outcomes were dichotomous indicators of potential bypassing of the nearest ED based on distance and time. As secondary outcomes we examined potential bypassing indicators based on excess driving distance and time.
We used Poisson regression models to obtain adjusted relative rates of potential bypassing indicators by acuity level, primary impression, patient demographics and geographic characteristics.
Our study cohort of 361,051 EMS transports consisted of 5.8% critical, 37.2% emergent and 57.0% low acuity cases transported to 222 EDs. The observed rate of potential bypassing was approximately 34% of cases for each acuity level. Treating the cardiovascular primary impression code group as the reference case, we found small to no differences in potential bypassing rates across other primary impression code groups of all acuity levels, with the exception of critical acuity trauma cases for which potential bypassing rate was 64% higher (incidence rate ratio = 1.64, 95% confidence interval, 1.54-1.74). Compared to zip codes with one ED within a 5-mile vicinity, potential bypassing was higher in areas with no ED or multiple EDs within a 5-mile vicinity.
Approximately one-third of EMS transports potentially bypassed the nearest ED. EMS transport destination may be motivated by factors other than proximity.
摘要：
指南建议将紧急医疗服务（EMS）患者运送到最近的适当急诊科（ED）。我们的目标是估计EMS运输到最近的ED（“潜在旁路”）以外的ED的患病率。
伊利诺伊州院前病人护理报告EMS运输数据（2019年7月至2019年12月）。
我们确定了所有EMS地面运输与先进的生命支持（ALS）护理人员为21岁及以上的患者的ED。使用事件位置的街道地址，我们进行了地理编码和行驶路线分析,并获得了到目的地ED和替代ED的估计行驶距离和时间.
我们的主要结果是基于距离和时间的最近ED潜在旁路的二分指标。作为次要结果，我们根据多余的驾驶距离和时间检查了潜在的绕过指标。
我们使用泊松回归模型来获得视敏度水平的潜在旁路指标的调整相对比率，主要印象,患者人口统计学和地理特征。
我们的研究队列361,051条EMS运输包括5.8%的关键,37.2%的急诊病例和57.0%的低视力病例转移到222例ED。对于每个敏锐度水平，观察到的潜在旁路率约为病例的34％。以心血管原发印象码组为参考病例，我们发现，在所有敏锐度水平的其他主要印象代码组中，潜在的旁路率存在很小或没有差异，除了严重的急性创伤病例，潜在的旁路率高出64%(发生率=1.64，95%置信区间，1.54-1.74)。与5英里附近有一个ED的邮政编码相比，在5英里附近没有ED或多个ED的地区，旁路的可能性更高。
大约三分之一的EMS运输可能绕过最近的ED。EMS运输目的地可能受邻近性以外的因素的影响。
伊利诺伊州院前病人护理报告EMS运输数据（2019年7月至2019年12月）。
我们确定了所有EMS地面运输与先进的生命支持（ALS）护理人员为21岁及以上的患者的ED。使用事件位置的街道地址，我们进行了地理编码和行驶路线分析,并获得了到目的地ED和替代ED的估计行驶距离和时间.
我们的主要结果是基于距离和时间的最近ED潜在旁路的二分指标。作为次要结果，我们根据多余的驾驶距离和时间检查了潜在的绕过指标。
我们使用泊松回归模型来获得视敏度水平的潜在旁路指标的调整相对比率，主要印象,患者人口统计学和地理特征。
我们的研究队列361,051条EMS运输包括5.8%的关键,37.2%的急诊病例和57.0%的低视力病例转移到222例ED。对于每个敏锐度水平，观察到的潜在旁路率约为病例的34％。以心血管原发印象码组为参考病例，我们发现，在所有敏锐度水平的其他主要印象代码组中，潜在的旁路率存在很小或没有差异，除了严重的急性创伤病例，潜在的旁路率高出64%(发生率=1.64，95%置信区间，1.54-1.74)。与5英里附近有一个ED的邮政编码相比，在5英里附近没有ED或多个ED的地区，旁路的可能性更高。
大约三分之一的EMS运输可能绕过最近的ED。EMS运输目的地可能受邻近性以外的因素的影响。
