The Dedicated Emergency Physician Model of emergency care is associated with reduced pre-hospital transportation time: A retrospective study with a nationwide database in Japan

Abstract

In Japan, the increasing number of patients needing emergency medical care due to population aging is a major public health problem. Recently, emergency medicine in Japan has seen a growth in the number of Dedicated Emergency Physician Model style departments. We aimed to determine whether there is an association between Dedicated Emergency Physician Model emergency care and pre-hospital transportation time. We conducted a secondary analysis of a Japanese national pre-hospital database from 2010 to 2014. Three regions (group 1: Urayasu city and Ichikawa city in Chiba prefecture, group 2: Kamakura city, Chigasaki city, Fujisawa city and Zushi city in Kanagawa prefecture, and group 3: Fukui city in Fukui prefecture) were evaluated as Dedicated Emergency Physician Model emergency medicine areas. We compared transportation times in these areas with all municipalities in the same prefectures, and with a nearby area using multivariate linear regression with cluster adjustment. The variables used for adjustment are the time from Emergency Medical Services activation to the scene, month, day of the month, day of the week, time of day, age, gender, type of injury, severity, and location of call. Compared with all municipalities in each prefecture there were significant reductions in pre-hospital transportation time: 4.2 minutes (95% confidence interval, 0.9 to 7.5, p<0.05) in Group 1, 6.2 minutes (95%CI, 2.9 to 9.6, p<0.01) fin Group 2 and 7.5 minutes (95%CI, 6.0 to 9.0, p<0.01) in Group 3. Compared with nearby areas, there were statistically significant reductions in transportation time in Group 1, 6.8 minutes (95%CI, 0.7 to 12.8, p<0.05) and in Group 2, 6.8 minutes (95%CI, 3.7 to 9.9, p<0.05). There was a trend for reduced transportation time in Group 3, 2.3 minutes, (5.3 to -0.6, p<0.1). Areas with a Dedicated Emergency Physician Model are associated with reduced pre-hospital transportation time.

Factors and impact of physicians’ diagnostic errors in malpractice claims in Japan

“…[4,5,27,28] The emergency room in Japan is a unique but high-risk setting where physicians are required to diagnose serious injuries or ailments even though many of them are not trained in emergency medicine. [31] Our results also suggest that DERC risk in outpatient departments is high. In addition, Japanese doctors working in primary care settings, including surgeons and internists, are forced to make clinical decisions with a high patient load in a limited amount of time.…”

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

“…In contrast, NAEDs are capable of handling geriatric emergency problems, in conjunction with a general internal medicine team. The contribution of NAEDs to reducing regional prehospital transportation time has been shown in another study 12) . Our findings add evidence to the assertion that NAEDs can increase the efficiency of the EMS system as a whole.…”

“…Some of their problems are combination of medical, surgical and social issues 17,18) . Increasing the number of NAEDs in Japan may be the most appropriate way to utilize social resources in an aging society 9,12) .…”

“…Some centers have moved away from the traditional model and have instead implemented the North American-style Emergency Departments (NAED). These NAEDs readily accept all types of patients and have been shown to contribute to the efficiency of local emergency medical services by eliminating diversion due to a narrow scope of practice 12) . Despite the evidence for improved efficiency, there is very little data available on the characteristics of the patients who are transported to NAEDs or the contribution of NAEDs during nighttime or weekend hours.…”

Factors associated with difficulty of hospital acceptance of patients suspected to have cerebrovascular diseases: A nationwide population-based observational study

“…Multivariate linear regression analysis was used to investigate the association between the factors and a reduction in pre-hospital transportation time. We selected covariates based on biological plausibility and previous studies in the multivariable analysis [ 2 , 6 , 21 ]. These variables included age (15–64 years, 65–84 years, ≧85 years), gender (male, female), time of day (daytime [09.00–16.59], night time [17.00–08.59]), day of the week (weekday, weekend), severity (mild, moderate, severe), location (home, public space, workplace, road, others), region (Hokkaido-Tohoku, Kanto, Chubu, Kansai, Chugoku, Shikoku, and Kyushu-Okinawa), month (January, February, March, April, May, June, July, August, September, October, November, December), the number of physicians per population in the area covered by each municipal fire department (<25 percentile, 25–74 percentile, ≧75 percentile), the proportion of emergency physicians to all physicians in the area (<25 percentile, 25–74 percentile, ≧75 percentile), the proportion of neurosurgeon to all physicians in the area (<25 percentile, 25–74 percentile, ≧75 percentile), population in the area, the proportion of older people to all people in the area, the proportion of younger people to all people in the area, per capita income in the area, industry ratio in the area (primary, secondary, tertiary), mean age of physicians in the area, and the proportion of female physicians in the area.…”