Abstract：
UNASSIGNED: Despite limited supporting data, hospitals continue to apply ambulance diversion (AD). Thus, we examined the impact of three different diversion policies on diversion hours, transport time (TT; leaving scene to arrival at the hospital), and ambulance patient offload time (APOT; arrival at the hospital to patient turnover to hospital staff) for 9-1-1 transports in a 22-hospital county Emergency Medical Services (EMS) system.
UNASSIGNED: This retrospective study evaluated metrics during periods of three AD policies, each 27 days long: hospital-initiated (Period 1), complete suspension (Period 2), and County EMS-initiated (Period 3). We described the median transports and diversion hours, and compared the daily average and daily 90th percentile TT and APOT during the three study periods.
UNASSIGNED: Over the study period, there were 50,992 total transports in the county; Period 3 had fewer median transports per day than Period 1 (581 vs 623, p < 0.001), while Period 2 was similar to Period 1 (606 vs 623, p = 0.108). Median average daily diversion hours decreased from 98.1 h during Period 1 to zero hours during both Periods 2 (p < 0.001) and 3 (p < 0.001). Median daily average TT decreased from 18.3 min in Period 1 to 16.9 min in both Periods 2 (p < 0.001) and 3 (p < 0.001). Median daily 90th percentile TT showed a similar decrease from 30.2 min in Period 1 to 27.5 in Period 2 (p < 0.001), and to 28.1 in Period 3 (p = 0.001). Median average daily APOT was 26.0 min during Period 1, similar at 25.2 min during Period 2 (p = 0.826) and decreased to 20.4 min during Period 3 (p < 0.001). The median daily 90th percentile APOT was 53.9 min during Period 1, similar at 51.7 min during Period 2 (p = 0.553) and decreased to 40.3 min during Period 3 (p < 0.001).
UNASSIGNED: Compared to hospital-initiated AD, enacting no AD or County EMS-initiated AD was associated with less diversion time; TT and APOT showed statistically significant improvement without hospital-initiated AD but were of unclear clinical significance. EMS-initiated AD was difficult to interpret as that period had significantly fewer transports. EMS systems should consider these findings when developing strategies to improve TT, APOT, and system use of diversion.
UNASSIGNED: This retrospective study evaluated metrics during periods of three AD policies, each 27 days long: hospital-initiated (Period 1), complete suspension (Period 2), and County EMS-initiated (Period 3). We described the median transports and diversion hours, and compared the daily average and daily 90th percentile TT and APOT during the three study periods.
UNASSIGNED: Over the study period, there were 50,992 total transports in the county; Period 3 had fewer median transports per day than Period 1 (581 vs 623, p < 0.001), while Period 2 was similar to Period 1 (606 vs 623, p = 0.108). Median average daily diversion hours decreased from 98.1 h during Period 1 to zero hours during both Periods 2 (p < 0.001) and 3 (p < 0.001). Median daily average TT decreased from 18.3 min in Period 1 to 16.9 min in both Periods 2 (p < 0.001) and 3 (p < 0.001). Median daily 90th percentile TT showed a similar decrease from 30.2 min in Period 1 to 27.5 in Period 2 (p < 0.001), and to 28.1 in Period 3 (p = 0.001). Median average daily APOT was 26.0 min during Period 1, similar at 25.2 min during Period 2 (p = 0.826) and decreased to 20.4 min during Period 3 (p < 0.001). The median daily 90th percentile APOT was 53.9 min during Period 1, similar at 51.7 min during Period 2 (p = 0.553) and decreased to 40.3 min during Period 3 (p < 0.001).
UNASSIGNED: Compared to hospital-initiated AD, enacting no AD or County EMS-initiated AD was associated with less diversion time; TT and APOT showed statistically significant improvement without hospital-initiated AD but were of unclear clinical significance. EMS-initiated AD was difficult to interpret as that period had significantly fewer transports. EMS systems should consider these findings when developing strategies to improve TT, APOT, and system use of diversion.
摘要：
目标：尽管支持数据有限，医院继续应用救护车改道(AD)。因此，我们研究了三种不同的分流政策对分流时间的影响，运输时间（TT；离开现场到达医院），和救护车患者卸载时间（APOT；到达医院到患者移交给医院工作人员），在22个医院的县紧急医疗服务（EMS）系统中进行9-1-1运输。方法：这项回顾性研究评估了三项AD政策期间的指标，每27天：医院启动（第1期），完全暂停(第二阶段)，和县EMS启动（第3期）。我们描述了运输和改道时间的中位数，并比较了三个研究期间的每日平均值和每日第90百分位TT和APOT。结果：在研究期间，该县共有50,992次运输量；第3期每天的运输量中位数少于第1期（581vs623，p<0.001），而第2期与第1期相似（606vs623，p=0.108）。平均每日分流小时数从第1期的98.1小时下降到第2期（p<0.001）和第3期（p<0.001）的零小时。每日平均TT中位数从第1期的18.3分钟下降到第2期（p<0.001）和第3期（p<0.001）的16.9分钟。每日90百分位数TT中位数显示出类似的下降，从第1期的30.2分钟下降到第2期的27.5（p<0.001），在第3期达到28.1(p=0.001)。在第1期，平均每日APOT中位数为26.0分钟，与第2期的25.2分钟相似（p=826），在第3期降低至20.4分钟（p<0.001）。在第1期期间，每日第90百分位数APOT的中位数为53.9分钟，在第2期期间为51.7分钟（p=0.553），在第3期期间降至40.3分钟（p<0.001）。结论：与医院引发的AD相比，制定无AD或县EMS引发的AD与更少的分流时间相关;TT和APOT在无医院引发AD的情况下显示统计学上显著改善,但临床意义不明确.EMS引发的AD难以解释，因为该时期的运输明显减少。EMS系统在制定改进TT的策略时，应考虑这些发现，APOT,和系统使用分流。
