Evaluation of factors associated with the difficulty in finding receiving hospitals for traffic accident patients at the scene treated by emergency medical services: a population‐based study in Osaka City, Japan

Katayama, Yusuke; Kitamura, Tetsuhisa; Kiyohara, Kosuke; Iwami, Taku; Kawamura, Takashi; Hayashida, Sumito; Ogura, Hiroshi; Shimazu, Takeshi

doi:10.1002/ams2.291

Cited by 12 publications

(26 citation statements)

References 8 publications

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“…In the Senshu medical control area in Osaka, Japan, Nakao and colleagues reported descriptive results of all emergency patients for whom fire departments had selected medical institutions, but they pointed out that there were excessive limitations to registering them when using a handwritten‐based registry . In contrast, multicenter registry research has been undertaken with the use of information technology, and the establishment of databases that linked ambulance records with in‐hospital information has been also achieved in some areas . Importantly, however, most of these databases were hospital‐based, and there were few population‐based registries at the regional or national level.…”

Section: Introductionmentioning

confidence: 99%

Profile of the ORION (Osaka emergency information Research Intelligent Operation Network system) between 2015 and 2016 in Osaka, Japan: a population‐based registry of emergency patients with both ambulance and in‐hospital records

Okamoto

Katayama

Kitamura

et al. 2018

Acute Medicine & Surgery

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AimTo describe the registry design of the Osaka Emergency Information Research Intelligent Operation Network system (ORION) and its profile of hospital information, patient and emergency medical service characteristics, and in‐hospital outcomes among all patients transported to critical care centers and emergency hospitals in Osaka Prefecture, Japan.MethodsThe Osaka Prefecture Government has developed and introduced an information system for emergency patients (the ORION system) that uses a smartphone application (app) for hospital selection by on‐scene emergency medical service personnel and has been accumulating all ambulance records. Since January 2015, medical institutions have obtained information on the diagnosis and outcome of patients transported to medical institutions, and the ORION system merged these data with ambulance records including smartphone app data.ResultsFrom January 2015 to December 2016, 753,301 eligible patients were registered. The mean age was 58.7 years, and 51.5% of patients were male. After hospital arrival, 39.7% were hospitalized, 58.2% were discharged from hospital, 1.1% changed hospital, and 1.0% died. The most common diagnoses were injury, poisoning, and certain other consequences of external causes. Among the hospitalized patients, 29.2% were continuously hospitalized, 59.0% discharged, 5.2% changed hospital, and 5.8% were dead at 21 days after hospitalization. The most common confirmed diagnosis was diseases of the circulatory system.ConclusionUsing the ORION system developed and operated by Osaka Prefecture since January 2015, we described the epidemiological data of all emergency patients transported to emergency hospitals. Analysis using the ORION database in the future could lead to improvements in the emergency transport system and patient outcomes.

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Section: Introductionmentioning

confidence: 99%

Profile of the ORION (Osaka emergency information Research Intelligent Operation Network system) between 2015 and 2016 in Osaka, Japan: a population‐based registry of emergency patients with both ambulance and in‐hospital records

Okamoto

Katayama

Kitamura

et al. 2018

Acute Medicine & Surgery

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“…In Japan, when emergency patients call for emergency medical service (EMS) at the scene, on-scene EMS personnel assess the patient’s condition and then transport the patient to a hospital that can accept and treat him or her [ 1 ]. In this process, ambulances can transport the patient to the hospital only after obtaining permission from the selected hospital via a phone call [ 1 ]; this permission is defined as hospital acceptance in Japan [ 2 ]. Recently, the number of emergency patients transported to a hospital by EMS has been increasing and exceeding the hospital capacity in Japan.…”

Section: Introductionmentioning

confidence: 99%

Improvements in Patient Acceptance by Hospitals Following the Introduction of a Smartphone App for the Emergency Medical Service System: A Population-Based Before-and-After Observational Study in Osaka City, Japan

Katayama

Kitamura

Kiyohara

et al. 2017

JMIR Mhealth Uhealth

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BackgroundRecently, the number of ambulance dispatches has been increasing in Japan, and it is therefore difficult for hospitals to accept emergency patients smoothly and appropriately because of the limited hospital capacity. To facilitate the process of requesting patient transport and hospital acceptance, an emergency information system using information technology (IT) has been built and introduced in various communities. However, its effectiveness has not been thoroughly revealed. We introduced a smartphone app system in 2013 that enables emergency medical service (EMS) personnel to share information among themselves regarding on-scene ambulances and the hospital situation.ObjectiveThe aim of this study was to assess the effects of introducing this smartphone app on the EMS system in Osaka City, Japan.MethodsThis retrospective study analyzed the population-based ambulance records of Osaka Municipal Fire Department. The study period was 6 years, from January 1, 2010 to December 31, 2015. We enrolled emergency patients for whom on-scene EMS personnel conducted hospital selection. The main endpoint was the difficulty experienced in gaining hospital acceptance at the scene. The definition of difficulty was making ≥5 phone calls by EMS personnel at the scene to hospitals until a decision to transport was determined. The smartphone app was introduced in January 2013, and we compared the patients treated from 2010 to 2012 (control group) with those treated from 2013 to 2015 (smartphone app group) using an interrupted time-series analysis to assess the effects of introducing this smartphone app.ResultsA total of 600,526 emergency patients for whom EMS personnel selected hospitals were eligible for our analysis. There were 300,131 emergency patients in the control group (50.00%, 300,313/600,526) from 2010 to 2012 and 300,395 emergency patients in the smartphone app group (50.00%, 300,395/600,526) from 2013 to 2015. The rate of difficulty in hospital acceptance was 14.19% (42,585/300,131) in the control group and 10.93% (32,819/300,395) in the smartphone app group. No change over time in the number of difficulties in hospital acceptance was found before the introduction of the smartphone app (regression coefficient: −2.43, 95% CI −5.49 to 0.64), but after its introduction, the number of difficulties in hospital acceptance gradually decreased by month (regression coefficient: −11.61, 95% CI −14.57 to −8.65).ConclusionsSharing information between an ambulance and a hospital by using the smartphone app at the scene was associated with decreased difficulty in obtaining hospital acceptance. Our app and findings may be worth considering in other areas of the world where emergency medical information systems with IT are needed.

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“…We used multivariate logistic regression to find patient characteristics associated with long transportation time. As covariates, distance of transportation from the scene (km), age, sex, reason of transportation (medical or surgical), relevant specialty determined by EMS, condition severity, time of request, weekday or holiday/Sunday, number of EMS negotiations until acceptance, reason for diversion by other hospitals were controlled for, based on a priori knowledge 9,11) .…”

Section: Discussionmentioning

confidence: 99%

“…This study also demonstrated that holiday/weekends or night-times were associated with difficulty in hospital acceptance 10) . A separate study of patients with traumatic injuries demonstrated that pediatric patients, moderate to severe trauma, holiday/weekends or night-times were also associated with difficulty in hospital acceptance 11) . Our study corroborates these prior studies and extends them by demonstrating that patient characteristics among patients transported to NAED were similar to the characteristics of those who experience difficulty in hospital acceptance.…”

Section: Discussionmentioning

confidence: 99%

“…Other emergency centers operate with limited resources such as on-call surgeons or on-call internists, which in turn limits the scope of patients that can be accepted from emergency medical services (EMS) transports 8) . This combination of tertiary and limited non-tertiary centers leads to inefficiency, diversion, and delayed care [9][10][11] . The increased burden of elderly emergency patients and risk of lawsuits have also caused numerous issues 9) .…”

Section: Introductionmentioning

confidence: 99%

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Factors Associated with Longer Transportation Time to North American Style Emergency Department in Japan

Shiga

Taira

Taira³

et al. 2019

J St. Marianna Univ

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Japanese emergency departments have traditionally been separated into tertiary and secondary centers. Tertiary emergency centers focus on the care of trauma and critically ill patients, while secondary emergency centers operate with limited resources and only accept patients of a limited acuity from emergency medical services (EMS). In contrast, North American-style Emergency Departments (NAED) have been developed, with the aim of accepting both critical and non-critical patients. We conducted a retrospective, observational study using municipal EMS records from 2012 in a Japanese city. Our aim was to identify patient characteristics associated with long EMS transportation times to NAED in an urban city where both traditional and NAED centers are available. The primary endpoint was long transportation time, defined as >35 minutes. Other items included the distance of transportation from the scene (km), age, sex, reason for transportation (medical or surgical), relevant specialty determined by EMS, condition severity, number of EMS negotiations until acceptance, and the reason for diversion by other hospitals. Multivariate logistic regression was used to find characteristics associated with long transportation time. A total of 2934 patients were included in the analysis. Median transportation time was 29 minutes . Characteristics that were associated with long transportation time included age (years) (OR, 1.02; 95%CI, 1.02-1.03; P<0.01), patients with orthopedic (OR, 1.69; 95%CI, 1.08-2.66; P=0.02) or neurosurgical (OR, 1.72; 95%CI, 1.21-2.47; P<0.01) conditions, and the number of EMS negotiations until acceptance (OR, 4.08; 95%CI, 3.12-5.33; P<0.01). Long transportation times were negatively associated with patients with medical (OR, 0.66; 95%CI, 0.46-0.96; P=0.03) and ear nose and throat (ENT) (OR, 0.13; 95%CI, 0.04-0.44; P<0.01) conditions. This is likely because the NAEDs fill an unmet need for patients that require certain types of care, such as surgical or neurosurgical treatment, or because they accept patients that have been refused by other centers.

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Evaluation of factors associated with the difficulty in finding receiving hospitals for traffic accident patients at the scene treated by emergency medical services: a population‐based study in Osaka City, Japan

Cited by 12 publications

References 8 publications

Profile of the ORION (Osaka emergency information Research Intelligent Operation Network system) between 2015 and 2016 in Osaka, Japan: a population‐based registry of emergency patients with both ambulance and in‐hospital records

Profile of the ORION (Osaka emergency information Research Intelligent Operation Network system) between 2015 and 2016 in Osaka, Japan: a population‐based registry of emergency patients with both ambulance and in‐hospital records

Improvements in Patient Acceptance by Hospitals Following the Introduction of a Smartphone App for the Emergency Medical Service System: A Population-Based Before-and-After Observational Study in Osaka City, Japan

Factors Associated with Longer Transportation Time to North American Style Emergency Department in Japan

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