An EMS transport destination officer is associated with reductions in simultaneous emergency department arrivals

Abstract

Objective: A centralized transport destination officer (TDO) is one technique used by EMS systems to distribute patients. This retrospective analysis examines the effect of a TDO on simultaneous arrivals and consecutive simultaneous arrivals at emergency departments in a suburban EMS system, and their relationship to transport unit throughput. Methods: Each system hospital arrival from July 1, 2020, to February 28, 2022, at six study hospitals was evaluated. An arrival within 300 seconds of the previous arrival at the same hospital was designated as a simultaneous arrival. Any simultaneous arrival where the previous arrival was also a simultaneous arrival was further designated as a consecutive simultaneous arrival. Simultaneous and consecutive simultaneous arrivals were aggregated by day to produce countywide daily totals, and days were weighted to account for volume variability. Median and interquartile ranges were calculated and compared, and a Wilcoxon rank-sum test was used for each outcome, with the presence of the TDO as the grouping variable. A Pearson correlation was used to assess the relationship between simultaneous and consecutive simultaneous arrivals to daily average hospital turnaround interval. Results: Median simultaneous arrivals and consecutive simultaneous arrivals decreased from 22 to 19 (non-TDO IQR =9) and from 6 to 4 per day (non-TDO IQR =5), respectively, on days when the TDO was in place. Simultaneous arrivals on non-TDO days had a rank-sum of 143582 compared to 41554 for TDO days (Asymp. Sig <0.001) and consecutive simultaneous arrivals on TDO days had a rank-sum of 142413 vs. 42722 for non-TDO days. (Asymp. Sig= <0.001) Increased simultaneous and consecutive simultaneous arrivals also showed statistically significant correlation with increased average turnaround interval (simultaneous r = 0.513, p < 0.001; consecutive simultaneous r = 0.362 p < 0.001). Conclusions: A centralized EMS transport destination officer is associated with a reduction in simultaneous and consecutive simultaneous arrivals of patients in the emergency department. Further analysis also shows a significant correlation between the number of simultaneous and consecutive simultaneous arrivals and transport unit hospital turnaround interval. This technique to achieve load balancing across transport destinations appears to be effective and can be considered in systems experiencing throughput difficulties.