Abstract
BackgroundIncreasing 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.MethodsWe 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.ResultsDuring 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.ConclusionsTransport 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.
Highlights
Increasing hospitalization rates present unique challenges to manage limited inpatient bed capacity and services
The cohort yielded 4,031,543 (18.5%) patients transported by paramedics and 17,733,097 (81.5%) patients self-referred to emergency department (ED)
12.6% (2,748,487) of all patients were admitted to the receiving hospital from ED, of which 51.4% (1,411,377) were transported by paramedics and 48.6% (1,337,110) by self-referral
Summary
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. Hospital admissions have increased steadily over the past 10 years in Ontario, Canada [1]. Hospital inpatient units have become increasingly congested and overburdened alongside increased patient complexity and occupancy loads [3, 4]. Higher admission rates are associated with older age, higher triage acuity, male sex, and certain chronic diseases (end-stage renal disease, chronic renal disease, congestive heart failure) [7,8,9,10,11,12]. While medical acuity and clinical conditions are the primary predictors of admission, additional non-medical characteristics (i.e., inadequate access to primary care, socioeconomic status, family member influences) may contribute [13, 14]
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