Transportation Preferences of Patients Discharged from the Emergency Department in the Era of Ridesharing Apps

Abstract

Patients discharged from the emergency department (ED) may encounter difficulty finding transportation home, increasing length of stay and ED crowding. We sought to determine the preferences of patients discharged from the ED with regard to their transportation home, and their awareness and past use of ridesharing services such as Lyft and Uber. Methods: We performed a prospective, survey-based study during a five-month period at a universityassociated ED and Level I trauma center serving an urban area. Subjects were adult patients who were about to be discharged from the ED. We excluded patients requiring ambulance transport home. Results: Of 500 surveys distributed, 480 (96%) were completed. Average age was 47 ± 19 years, and 61% were female. There were 33,871 ED visits during the study period, and 67% were discharged home. The highest number of subjects arrived by ambulance (27%) followed by being dropped off (25%). Of the 408 (85%) subjects aware of ridesharing services, only eight (2%) came to the ED by this manner; however, 22 (5%) planned to use these services post-discharge. The survey also indicated that 377 (79%) owned smartphones, and 220 (46%) used ridesharing services. The most common plan to get home was with family/friend (35%), which was also the most preferred (29%). Regarding awareness and past use of ridesharing services, we were unable to detect any gender and/or racial differences from univariate analysis. However, we did detect age, education and income differences regarding awareness, but only age and education differences for past use. Logistic regression showed awareness and past use decreased with increasing patient age, but correlated positively with increasing education and income. Half the subjects felt their medical insurance should pay for their transportation, whereas roughly one-third felt ED staff should pay for it. Conclusion: Patients most commonly prefer to be driven home by a family member or friend after discharge from the ED. There is awareness of ridesharing services, but only 5% of patients planned to use these services post-discharge from the ED. Patients who are older, have limited income, and are less educated are less likely to be aware of or have previously used ridesharing services. ED staff may assist these patients by hailing ridesharing services for them at time of discharge. [West J Emerg Med. 2019;20(4)672-680.]

A Pilot Randomized Controlled Trial of the PTSD Coach App Following Motor Vehicle Crash–related Injury

“…In veterans and civilians with established PTSD, it has been shown to reduce PTSD and associated symptoms 30–33 . Approximately 79% of ED patients in Level I trauma centers own smartphones 34 . Given this increased access, and that Hispanic and black individuals are more likely to rely on their mobile phone (vs. other devices) to access the Internet and health‐related information (see Anderson‐Lewis et al 35 ), PTSD Coach may present a unique opportunity to engage minority populations in mental health care and provide accessible and sustainable mental health care to underserved populations; 36 however, few evidence‐based digital tools are designed to prevent postinjury PTSD 27 (for exception, see Mouthaan et al 37 ), and no prior study has tested a PTSD‐focused self‐management mHealth app for ED patients with minor injuries.…”

Ridesharing as an Alternative to Ambulance Transport for Voluntary Psychiatric Patients in the Emergency Department

“…15,16 These ridesharing services have also piqued the interest of hospital systems aiming to provide non-emergency medical transportation services to their patients. [17][18][19] These efforts are bolstered by studies in primary care demonstrating improved show-rates when using ridesharing services, although other studies have not definitively demonstrated benefits in decreasing no-show rates. 22,23 Despite the broad availability of ridesharing services and their increasing utilization by hospital systems, there are no studies on the use of taxi services and limited research on the effect of ridesharing on ED LOS after discharge or interfacility transport.…”

Modelling Granular Process Flow Information to Reduce Bottlenecks in the Emergency Department

“…A lower score could lead to alerting the discharge team, which can then put in place an appropriate package of care to facilitate safe and direct discharge from the ED. At the hospital, some patients were unable to exit the ED upon discharge due to lack of transportation, a problem that has been reported through other studies as well [53,118]. As a result, patients ended up boarding while ED staff had to spend time arranging for transport.…”

“…For instance, specialist consultation, necessary to process complex patients, is a common throughputrelated bottleneck [50,52]. An output-specific bottleneck might be discharged patients who are unable to egress the ED due to the non-availability of transportation [53].…”

“…As a result, patients ended up boarding while ED staff had to spend time arranging for transport. This can divert staff time necessary to process other patients and add to crowding [53]. The need for transportation is recorded on the CAS card when a discharge decision has been made (Figure 2: P49).…”