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Academic Emergency Medicine : Official... Jan 2009The objective was to study the association between ambulance diversion and weekly inpatient hospital revenues and profits. (Comparative Study)
Comparative Study
OBJECTIVES
The objective was to study the association between ambulance diversion and weekly inpatient hospital revenues and profits.
METHODS
This was a retrospective review of administrative data from one academic medical center from July 1, 2003, to December 31, 2006. Given the high amount of daily variability, inpatient hospital revenues and profits were collapsed by week and evaluated in four categories: no diversion, mild diversion (from >0 and <10 hours), moderate diversion (>10 and <20 hours), and high diversion (>20 hours). Revenues and profits for two categories of patients admitted to the hospital were calculated: 1) patients admitted from the emergency department (ED; i.e., those arriving by ambulance and by other means) and 2) electively admitted patients.
RESULTS
A total of 166,460 ED patients were included in the analysis. Inpatient hospital revenues were included from 85,111 patients, 28,665 of which were admissions from the ED (33.7%). For patients admitted from the ED, the average weekly revenues during periods of high diversion were $265K higher than periods of no diversion. For patients admitted on an elective basis, revenues were significantly higher when comparing periods of mild divert to high diversion (an additional $415K weekly). The overall increase in profitability was significant for periods of severe divert compared to no divert ($119K per week).
CONCLUSIONS
Periods of greater diversion are associated with higher inpatient revenues and profits for ED, electively admitted patients, and the overall inpatient hospital population. Therefore, no financial disincentive exists from an inpatient perspective for the boarding of admitted patients in the ED and increasing periods of diversion. Efforts to decrease ambulance diversion must therefore be based on other rationales, like patient safety, quality of care, and improving access to care, or new models of reimbursement that reward hospitals for reducing ambulance diversion.
Topics: Academic Medical Centers; Ambulances; Economics, Hospital; Emergency Service, Hospital; Humans; Oregon; Patient Admission; Patient Transfer; Retrospective Studies
PubMed: 18785941
DOI: 10.1111/j.1553-2712.2008.00242.x -
Tidsskrift For Den Norske Laegeforening... Jan 2024The Western Norway Regional Health Authority uses SATS Norge (SATS-N), a modified version of the South African Triage Scale, in all accident and emergency departments... (Observational Study)
Observational Study
BACKGROUND
The Western Norway Regional Health Authority uses SATS Norge (SATS-N), a modified version of the South African Triage Scale, in all accident and emergency departments (A&E) and ambulance services in the region. The purpose of the study was to examine the validity of the paediatric component of SATS-N used for children transported to hospital by ambulance for emergency medical assistance.
MATERIAL AND METHOD
We conducted a retrospective observational study which included all children in the age group 0-14 years, admitted by ambulance to A&E at Haukeland University Hospital for emergency medical assistance in the period from January to June 2020. The five triage levels in SATS-N were dichotomised to high triage level (the two highest triage categories) or low triage level (the three lowest triage categories). Sensitivity was calculated as the proportion of patients assigned to the high triage level among those who were directly transferred from A&E to a high dependency unit, and specificity as the proportion of patients assigned to the low triage level among those who were not directly transferred to a high dependency unit.
RESULTS
Of a total of 303 patient transports, 270 (89 %) were triaged in the ambulance and 243 (80 %) in the A&E. In the pre-hospital and A&E settings, the sensitivity of SATS-N was 96 % and 88 %, and specificity was 46 % and 60 %, respectively.
INTERPRETATION
For children admitted to hospital by ambulance, SATS-N had high sensitivity and low specificity for identifying patients who needed to be directly transferred from A&E to a high dependency unit.
Topics: Adolescent; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Acute Disease; Ambulances; Emergency Medical Services; Emergency Service, Hospital; Hospitals, University; Norway; Retrospective Studies; Transportation of Patients; Triage
PubMed: 38258724
DOI: 10.4045/tidsskr.23.0480 -
BMC Medical Ethics Jan 2024It is a common ethical challenge for ambulance clinicians to care for patients with impaired decision-making capacities while assessing and determining the degree of...
BACKGROUND
It is a common ethical challenge for ambulance clinicians to care for patients with impaired decision-making capacities while assessing and determining the degree of decision-making ability and considering ethical values. Ambulance clinicians' ethical competence seems to be increasingly important in coping with such varied ethical dilemmas. Ethics rounds is a model designed to promote the development of ethical competence among clinicians. While standard in other contexts, to the best of our knowledge, it has not been applied within the ambulance service context. Thus, the aim of this study was to describe ambulance clinicians' experiences of participating in ethics rounds.
METHODS
This was a qualitative descriptive study, evaluating an intervention. Data were collected through sixteen interviews with ambulance clinicians who had participated in an intervention involving ethics rounds. The analysis was performed by use of content analysis.
RESULTS
Two themes describe the participants' experiences: (1) Reflecting freely within a given framework, and (2) Being surprised by new insights. The following categories form the basis of the themes; 1a) Gentle guidance by the facilitator, 1b) A comprehensible structure, 2a) New awareness in the face of ethical problems, and 2b) Shared learning through dialogue.
CONCLUSION
Incorporating structured ethics rounds seems to create a continuous development in ethical competence that may improve the quality of care in the ambulance service. Structured guidance and facilitated group reflections offer ambulance clinicians opportunities for both personal and professional development. An important prerequisite for the development of ethical competence is a well-educated facilitator. Consequently, this type of ethics rounds may be considered a useful pedagogical model for the development of ethical competence in the ambulance service.
Topics: Humans; Ambulances; Qualitative Research
PubMed: 38238736
DOI: 10.1186/s12910-024-01002-6 -
Emergencias : Revista de La Sociedad... Jun 2023
Topics: Humans; Ambulances; Feasibility Studies; Stroke; Emergency Medical Services
PubMed: 37350596
DOI: 10.55633/s3me/E056.2023 -
Revista Brasileira de Enfermagem 2021To reflect on the safe care exercised by the pre-hospital care team by emergency ambulance in times of coronavirus infection.
OBJECTIVE
To reflect on the safe care exercised by the pre-hospital care team by emergency ambulance in times of coronavirus infection.
METHOD
A reflection and description of how to provide safe care to the patient and the professional during pre-hospital care in times of coronavirus infection.
RESULTS
To ensure the health of all those involved in the care, health professionals who work in pre-hospital care by emergency ambulance should use the recommended Personal Protective Equipment (PPE), such as the use of surgical masks and N95, N99, N100, PFF2 or PFF3, the use of an apron or overall, goggles and face shield, gloves and a hat. The entire team must receive training and demonstrate the ability to use PPE correctly and safely.
FINAL CONSIDERATIONS
The professional working in the pre-hospital care by ambulance is exposed to a series of occupational risks that need to be discussed and minimized through professional training.
Topics: Adult; Ambulances; Brazil; COVID-19; Emergency Medical Services; Emergency Medical Technicians; Female; Humans; Infectious Disease Transmission, Patient-to-Professional; Male; Middle Aged; Patient Safety; Personal Protective Equipment; Practice Guidelines as Topic; SARS-CoV-2; Transportation of Patients
PubMed: 33605363
DOI: 10.1590/0034-7167-2020-0657 -
BMC Medical Education Mar 2022It is known that setting and context matters, and contextual factors influence interprofessional education (IPE). Activities developed in a new setting should therefore...
BACKGROUND
It is known that setting and context matters, and contextual factors influence interprofessional education (IPE). Activities developed in a new setting should therefore be evaluated to determine students' experiences and learning. IPE in the ambulance service may present a new setting for interprofessional learning (IPL).
AIM
The aim of this study was to explore undergraduate students' experiences of collaboration and learning together during their clinical rotation in the ambulance service.
STUDY DESIGN AND METHOD
A mixed convergent parallel design was used to describe nursing and medical students' experiences of collaboration and learning together during their clinical rotation in the ambulance service during autumn 2019. Two group interviews with nursing students (n = 20; response rate 80%) were conducted and the medical students (n = 40; response rate 72.5%) answered a self-assessment questionnaire regarding their IPE. The group discussions were analysed using an inductive thematic analysis and descriptive statistics were used to describe the medical students' self-assessed experiences and competencies in interprofessional collaboration.
RESULTS
In the context of the ambulance service, some of the challenges included, the team vary daily, a context that can be unpredictable, and the team being required to make decisions in various situations with limited support. The context presented good opportunities to learn together, since they faced a broad variety of situations and had opportunities to follow patients through the chain of care.
CONCLUSION
The students' experiences show that the ambulance service offers possibilities for IPL. The ambulance service enhanced the students' learning in an unfamiliar environment, encouraging them to develop collaborative learning strategies and situational leadership regardless of established hierarchical structures and stereotypes that are sometimes present in other parts of the health care service.
ETHICAL APPROVAL
By the Swedish Ethical Review Authority. No: 2019-03595.
Topics: Ambulances; Humans; Interdisciplinary Placement; Interprofessional Relations; Learning; Students, Nursing
PubMed: 35307011
DOI: 10.1186/s12909-022-03251-8 -
Internal and Emergency Medicine Mar 2024Accurate estimation of ambulance transport time from the scene of incident to arrival at the emergency department (ED) is important for effective resource management and...
Accurate estimation of ambulance transport time from the scene of incident to arrival at the emergency department (ED) is important for effective resource management and emergency care system planning. Further, differences in transport times between different urgency levels highlight the benefits of ambulance transports with highest urgency level in a setting where ambulances are allowed to not follow standard traffic rules. The objective of the study is to compare ambulance urgency level on the differences in estimates of ambulance transport times generated by Google Maps and the observed transport times in a prehospital setting where emergency vehicles have their own traffic laws. The study was designed as a natural experiment and register study. Ambulance transports dispatched with different levels of urgency (Level A and B) were included in the Central Denmark Region (a mixed urban and rural area) from March 10 to June 11, 2021. Ambulance transports for highest urgency level were compared to lowest urgency level with Google Maps estimated transport times as reference. We analyzed 1981 highest urgency level and 8.958 lowest urgency level ambulance transports. Google Maps significantly overestimated the duration of transports operating at highest level of urgency (Level A) by 1.9 min/10 km (95% CI 1.8; 2.0) in average and 4.8 min/10 km (95% CI 3.9; 5.6) for the first driven 10 km. Contrary, Google Maps significantly underestimated the duration of transports operating at lowest level of urgency (Level B) by -1.8 min/10 km (95% CI -2.1; -1.5) in average and -4.4 min/10 km (95% CI -5.4; -3.5) for the first driven 10 km. Google Maps systematically overestimates transport times of ambulance transports driven with Level A, the highest level of urgency in a setting where ambulances are allowed to not follow standard traffic rules. The results highlight the benefit of using urgency Level A and provide valuable information for emergency care management.
Topics: Humans; Emergency Medical Services; Ambulances; Emergency Service, Hospital
PubMed: 38123903
DOI: 10.1007/s11739-023-03501-7 -
The Science of the Total Environment May 2022In summer 2020 under the COVID-19 pandemic, the Ministry of Health, Labour and Welfare has made public warnings that specific preventive measures such as maskwearing and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
In summer 2020 under the COVID-19 pandemic, the Ministry of Health, Labour and Welfare has made public warnings that specific preventive measures such as maskwearing and stay-at-home orders, may increase heatstroke risk. In our previous work, we found a lower risk of heatstroke-related ambulance dispatches (HSAD) during the COVID-19 period, however, it is uncertain whether similar risk reductions can be observed in different vulnerable subgroups. This study aimed to determine the HSAD risk during the COVID-19 pandemic by age, severity, and incident place subgroups.
METHOD
A summer-specific (June-September), time-series analysis was performed, using daily HSAD and meteorological data from 47 Japanese prefectures from 2017 to 2020. A two-stage analysis was applied to determine the association between HSAD and COVID-19 pandemic, adjusting for maximum temperature, humidity, seasonality, and relevant temporal adjustments. A generalized linear model was utilized in the first stage to estimate the prefecture-specific effect estimates. Thereafter, a fixed effect meta-analysis in the second stage was implemented to pool the first stage estimates. Subsequently, subgroup analysis via an interaction by age, severity, and incident place was used to analyze the HSAD risk among subgroups.
RESULTS
A total of 274,031 HSAD cases was recorded across 47 Japanese prefectures. The average total number of HSAD in the pre-COVID-19 period was 69,721, meanwhile, the COVID-19 period was 64,869. Highest reductions in the risks was particularly observed in the young category (ratio of relative risk (RRR) = 0.54, 95% Confidential Interval (CI): 0.51, 0.57) compared to the elderly category. Whereas highest increment in the risks were observed in severe/death (RRR = 1.25, 95% CI: 1.13, 1.37) compared to the mild category.
CONCLUSION
COVID-19 situation exhibited a non-uniform change in the HSAD risk for all subgroups, with the magnitude of the risks varying by age, severity, and incident place.
Topics: Ambulances; COVID-19; Emergency Medical Services; Heat Stroke; Humans; Humidity; Japan; Pandemics
PubMed: 35085629
DOI: 10.1016/j.scitotenv.2022.153310 -
BMJ Open Jul 2023To explore health problems and the recovery process after being deployed in a major incident.
OBJECTIVES
To explore health problems and the recovery process after being deployed in a major incident.
DESIGN
Qualitative, explorative design.
SETTING
Ambulance services in Sweden.
PARTICIPANTS AND METHODS
Semistructured, individual two-session interviews with 15 ambulance nurses with the experience of being deployed to major incidents were conducted. Data were analysed with thematic analysis.
RESULTS
Being deployed in major incidents was perceived to be straining and led to both physical health problems and distress. To recover, the ambulance nurses strived to use strategies to distance themselves from the situation and created supportive conditions for their recovery, and if successful, the experiences led to both professional and personal growth and self-awareness. However, being deployed in major incidents without significant preparedness or experience could harm individuals and, in the worst case, end their career.
CONCLUSIONS
A successful recovery from the physical and mental exhaustion experienced after being deployed in a major incident required both individual abilities and self-care strategies as well as a supportive working environment. Supporting individual recovery strategies and following up on physical and mental well-being over time should be part of all ambulance services procedures after major incidents.
Topics: Humans; Ambulances; Sweden; Qualitative Research; Nurses
PubMed: 37407063
DOI: 10.1136/bmjopen-2023-071848 -
Scandinavian Journal of Trauma,... Jan 2024Working in rural areas involves tackling long distances and occasional lack of supportive resources. Ambulance nurses are faced with the responsibility of making...
BACKGROUND
Working in rural areas involves tackling long distances and occasional lack of supportive resources. Ambulance nurses are faced with the responsibility of making immediate autonomous decisions and providing extended care to critically ill patients during prolonged ambulance transport to reach emergency medical facilities. This study aims to expose the experiences of ambulance nurses acting as primary caregivers for critically ill patients during lengthy ambulance transfers in rural regions.
METHOD
Fifteen nurses employed in an ambulance service within sparsely populated rural areas were subjected to semi-structured interviews. The collected data underwent qualitative content analysis.
RESULT
The analysis resulted in one overarching theme with two categories. The theme is 'Safety in the Professional Role,' and the two categories are 'Working in sparsely populated areas presents challenges' and 'Rare events: when routine cannot be established.' The findings suggest that working as an ambulance nurse in a rural setting poses various challenges that can be highly stressful. Delivering care to critically ill patients during extended ambulance transports requires the knowledge, experience, and careful planning of the healthcare provider in charge.
CONCLUSIONS
The findings underscore the necessity for thorough planning and adaptable thinking when attending to critically ill patients during extended transport scenarios. The absence of supporting resources can render the task demanding. Nevertheless, participants reported an inherent tranquility that aids them in maintaining focus amid their responsibilities.
Topics: Humans; Caregivers; Ambulances; Critical Illness; Qualitative Research; Nurses
PubMed: 38263118
DOI: 10.1186/s13049-024-01178-1