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10.1016/j.ajem.2023.02.021
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Title
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Patients utilizing emergency medical services - Does facility type matter?
Creator
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Erin L Simon
Bhanu Wahi-Singh
Baruch S Fertel
Luke Weber
Jessica Krizo
Caroline Mangira
Courtney M Smalley
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
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Background: Emergency departments (EDs) play a critical role in the US healthcare system. As freestanding EDs (FSEDs) are integrated into the acute care landscape, local EMS providers are transporting to these facilities, which may be closer in proximity and provide faster turnaround times. We hypothesized that patients transported via EMS to a freestanding ED required fewer tests and are admitted less frequently than those transported to a HBED. Our objective was to compare testing frequency and admission rates between patients transported via EMS to a FSED vs. HBED.
Methods: This was a retrospective cohort study of all patients who presented within a large integrated hospital system via EMS to one of 10 HBEDs or one of 6 FSEDs between April 1, 2020 - May 1, 2021. Categorical variables are presented as frequencies and percentages and comparisons between groups were obtained using chi squared tests. Continuous variables are presented as mean and standard deviation and p-values comparing groups were obtained using t-tests. Multiple logistic regression was used to assess the effect of ED type on admission status, labs ordered, and testing performed.
Results: A total of 123,120 encounters were included in our study. Mean age at the FSEDs was 59.9 vs. 61.3 at the HBEDs. At the FSEDs 55.6% (n = 4675) were female vs. 53.0% (n = 60,809) at the HBEDs. At the FSEDs 82.0% (n = 6805) were White vs. 60.7% (n = 68,430) at the HBEDs. We found 50.0% (n = 3974) had Medicare at the FSEDs vs 50.9% (n = 55,372) at the FSEDs. At the FSEDs, 69.5% (n = 5846) had bloodwork vs. 82.4% (n = 94,512) at the HBEDs; 68.3% (n = 5745) had an x-ray at the FSEDs vs. 70.7% (n = 81,089) at the HBEDs; 40.1% (n = 3370) had a CT scan at the FSEDs vs. 44.9% (n = 51,503) at the HBEDs; and 40.6% (n = 3412) were admitted at the FSEDs vs. 56.1% (n = 64,355) at the HBEDs. After controlling for Charlson Comorbidity Index, acuity, age, gender, sex, insurance and race, patients in FSEDs were 35% less likely to be admitted as compared to HBEDs.
Conclusion: Patients brought in via EMS to a FSED were less likely to have blood work, x-ray, or CT scan, and were less likely to be admitted to the hospital than those transported to a HBED.
Source
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Am J Emerg Med
. 2023 Feb 21;68:38-41. doi: 10.1016/j.ajem.2023.02.021. Online ahead of print.
Language
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English
2023
Admission rate
Emergency Medical Services
Freestanding emergency department
testing frequency
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<a href="http://doi.org/10.1016/j.ajem.2017.10.066" target="_blank" rel="noreferrer noopener">http://doi.org/10.1016/j.ajem.2017.10.066</a>
Pages
967–971
Issue
6
Volume
36
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Title
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Variation in hospital admission rates between a tertiary care and two freestanding emergency departments.
Publisher
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The American journal of emergency medicine
Date
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2018
2018-06
Subject
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Admission rate; Ambulatory Care Facilities; Chi Square Test; Confidence Intervals; Emergency Service – Methods; Fisher's Exact Test; Freestanding emergency department; Human; Multiple Logistic Regression; Odds Ratio; Office Visits; Patient Admission; Patient Classification; Retrospective Design; Sex Factors; T-Tests; Tertiary Health Care
Creator
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Simon Erin L; Dark Cedric; Kovacs Mitch; Shakya Sunita; Meek Craig A
Description
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BACKGROUND: Recently, freestanding emergency departments (FSEDs) have grown significantly in number. Critics have expressed concern that FSEDs may increase healthcare costs. OBJECTIVE: We determined whether admission rates for identical diagnoses varied among the same group of physicians according to clinical setting. METHODS: This was a retrospective comparison of adult admission rates (n=3230) for chest pain, chronic obstructive pulmonary disease (COPD), asthma, and congestive heart failure (CHF) between a hospital-based ED (HBED) and two FSEDs throughout 2015. Frequency distribution and proportions were reported for categorical variables stratified by facility type. For categories with cell frequency less or equal to 5, Fisher's Exact test was used to calculate a P value. Chi square tests were used to assess difference in proportions of potential predictor variables between the HBED and FSEDs. For continuous variables, the mean was reported and Student's t-test assessed the difference in means between HBED and FSED patients. Multivariate logistic regression analyses were performed to estimate the unadjusted and adjusted prevalence odds ratio with 95% confidence interval (CI) for patient disposition outcomes associated with type of ED facility visited. RESULTS: Of 3230 patients, 53% used the HBED and 47% used the FSED. Patients visiting the HBED and FSED varied significantly in gender, acuity levels, diagnosis, and number of visits. Age was not significantly different between facilities. Multivariable adjusted estimated prevalence odds ratio for patients admitted were 1.2 [95%CI: 1.0-1.4] in the HBED facility compared to patients using FSEDs. CONCLUSION: In our healthcare system, FSEDs showed a trend towards a 20% lower admission rate for chest pain, COPD, asthma and CHF.
Identifier
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<a href="http://doi.org/10.1016/j.ajem.2017.10.066" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2017.10.066</a>
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2018
Admission rate
Ambulatory Care Facilities
Chi Square Test
Confidence Intervals
Dark Cedric
Department of Emergency Medicine
Emergency Service – Methods
Fisher's Exact Test
Freestanding emergency department
Human
Kovacs Mitch
Meek Craig A
Multiple Logistic Regression
NEOMED College of Medicine
Odds Ratio
Office Visits
Patient Admission
Patient Classification
Retrospective Design
Sex Factors
Shakya Sunita
Simon Erin L
T-Tests
Tertiary Health Care
The American journal of emergency medicine