Abstract
Abstract
Background
Increasing hospitalization rates present unique challenges to manage limited inpatient bed capacity and services. Transport by paramedics to the emergency department (ED) may influence hospital admission decisions independent of patient need/acuity, though this relationship has not been established. We examined whether mode of transportation to the ED was independently associated with hospital admission.
Methods
We conducted a retrospective cohort study using the National Ambulatory Care Reporting System (NACRS) from April 1, 2015 to March 31, 2020 in Ontario, Canada. We included all adult patients (≥18 years) who received a triage score in the ED and presented via paramedic transport or self-referral (walk-in). Multivariable binary logistic regression was used to determine the association of mode of transportation between hospital admission, after adjusting for important patient and visit characteristics.
Results
During the study period, 21,764,640 ED visits were eligible for study inclusion. Approximately one-fifth (18.5%) of all ED visits were transported by paramedics. All-cause hospital admission incidence was greater when transported by paramedics (35.0% vs. 7.5%) and with each decreasing Canadian Triage and Acuity Scale level. Paramedic transport was independently associated with hospital admission (OR = 3.76; 95%CI = 3.74–3.77), in addition to higher medical acuity, older age, male sex, greater than two comorbidities, treatment in an urban setting and discharge diagnoses specific to the circulatory or digestive systems.
Conclusions
Transport by paramedics to an ED was independently associated with hospital admission as the disposition outcome, when compared against self-referred visits. Our findings highlight patient and visit characteristics associated with hospital admission, and can be used to inform proactive healthcare strategizing for in-patient bed management.
Publisher
Springer Science and Business Media LLC
Reference30 articles.
1. Canadian Institute for Health Information. Inpatient Hospitalization, Surgery and Newborn Statistics, 2018–2019. Ottawa: CIHI; 2020.
2. Forster AJ, Stiell I, Wells G, Lee AJ, van Walraven C. The effect of hospital occupancy on emergency department length of stay and patient disposition. Acad Emerg Med Off J Soc Acad Emerg Med. 2003;10(2):127–33. https://doi.org/10.1197/aemj.10.2.127.
3. Kone AP, Mondor L, Maxwell C, Kabir US, Rosella LC, Wodchis WP. Rising burden of multimorbidity and related socio-demographic factors: a repeated cross-sectional study of Ontarians. Can J Public Health. 2021;112(4):737–47. https://doi.org/10.17269/s41997-021-00474-y.
4. Devlin R. Hallway health care: a system under strain. Toronto: Government of Ontario; 2019. Available from: https://www.health.gov.on.ca/en/public/publications/premiers_council/docs/premiers_council_report.pdf.
5. OECD. Hospital beds (indicator); 2020. Available from. https://doi.org/10.1787/0191328e-en.