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Epperformed RUQ US:

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Factors Associated with Utilization of Emergency Medical Services in an ... Jennifer Ruger, PhD. Christopher Richter, MD. Lawrence Lewis, MD. Presented at the: ... – PowerPoint PPT presentation

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Title: Epperformed RUQ US:

1
Factors Associated with Utilization of Emergency
Medical Services in an Urban Academic Hospital
Jennifer Ruger, PhD Christopher Richter,
MD Lawrence Lewis, MD
Division of Emergency Medicine Washington
University School of Medicine St. Louis, Missouri
2
Presented at the American College of
Emergency Physicians (ACEP) Annual Meeting
3
Context

Recent concern about ambulance diversion and
emergency department (ED) overcrowding has
increased scrutiny of the emergency medical
services (EMS) system
Little is known, however, about the factors
associated with EMS use or the factors that favor
the use of EMS transportation as compared to
other modes of arrival

4
Background

Previous studies have been limited in size,
scope, and the ability to control for confounding
factors, such as clinical acuity at presentation
Moreover, they have primarily consisted of
post-hoc investigations of EMS misuse or
inappropriate use

5
Objective

To identify factors associated with mode of
transportation to an ED associated with an urban
academic hospital

6
Methods

A retrospective, cross-sectional study of all
patients seen during calendar year 2001 with
complete data on mode of arrival in the ED of a
large, urban academic hospital
Data was obtained from three of the hospitals
databases
Clinical
Admissions
Financial

7
Methods
continued

Mode of arrival was divided into six categories
Bus
Car
Helicopter
Walk-In
City EMS
County EMS

8
Results
Calendar Year 2001 78,735 ED patients
Frequency
Percent
Car
53,784
70.5
City EMS
12,665
16.6
Bus
4,669
5.7
County EMS
3,855
5.1
Walk-in
1,394
1.8
Helicopter
253
0.3
9
Results
continued
Factors Significantly Associated with EMS Use

Being in a motor vehicle crash
OR 7.71 (95 CI 7.08 - 8.4)
Suffering a gunshot or stab wound
OR 5.95 (95 CI 4.68 - 7.55)
Triage acuity level A or B
OR 3.4 (95 CI 3.27 - 3.58)

.
.
.
10
Results
continued
Factors Significantly Associated with EMS Use

Being admitted to the intensive care unit or
operating room or dying
OR 2.71 (95 CI 2.39 - 3.08)
Falling 0 to 10 feet
OR 2.28 (95 CI 2.04 - 2.56)
Having Medicaid Traditional
OR 2.07 (95 CI 1.74 - 2.47)

.
.
.
11
Results
continued
Factors Significantly Associated with EMS Use

DRG severity level 4 (most severe)
OR 1.98 (95 CI 1.68 - 2.34)
Medicare Traditional
OR 1.79 (95 CI 1.50-2.14)
Being admitted to the hospital or dying after
arriving at the ED
OR 1.60 (95 CI 1.51-1.69)

.
.
.
12
Results
continued
Factors Significantly Associated with EMS Use

Being a self-payor or uninsured
OR 1.53 (95 CI 1.28 - 1.82)
Being age 65 or older
OR 1.48 (95 CI 1.36 - 1.62)
DRG severity level 3
OR 1.47 (95 CI 1.31 - 1.66)

13
Discussion

To our knowledge this study is the first to
examine the relationship between a number of
clinical and demographic variables and the chosen
mode of transportation to an ED
Our patient sample was large. Extensive
clinical, financial and administrative data
allowed us to examine and control for previously
unstudied patient characteristics

14
Conclusion

In this study, EMS utilization related to
Severity of injury or illness
Age
Health insurance status
Patients utilizing EMS were more acutely sick or
more severely injured than those not using EMS
Our findings do not support the perception of
significant inappropriate EMS utilization

15
Recommendation