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Are emergency medical services offload delay patients at increased risk of adverse outcomes?

  • Dana Stewart (a1), Eddy Lang (a1), Dongmei Wang (a1) and Grant Innes (a1)
Abstract
Objective

Emergency department (ED) and hospital overcrowding cause offload delays that remove emergency medical services (EMS) crews from service and compromise care delivery. Prolonged ED boarding and delays to inpatient care are associated with increased hospital length of stay (LOS) and patient mortality, but the effects of EMS offload delays have not been well studied.

Methods

We used administrative data to study all high-acuity Canadian Triage Acuity Scale 2–3 EMS arrivals to Calgary adult EDs from July 2013 to June 2016. Patients offloaded to a care space within 15 minutes were considered controls, whereas those delayed ≥ 60 minutes were considered “delayed.” Propensity matching was used to create comparable control and delayed cohorts. The primary outcome was 7-day mortality. Secondary outcomes included hospital LOS and 30-day mortality.

Results

Of 162,002 high-acuity arrivals, 70,711 had offload delays <15 minutes and 41,032 had delays > 60 minutes. Delayed patients were more likely to be female, older, to have lower triage acuity, to live in dependent living situations, and to arrive on weekdays and day or evening hours. Delayed patients less often required admission and, when admitted, were more likely to go to the hospitalist service. Main outcomes were similar for propensity-matched control and delayed cohorts, although delayed patients experienced longer ED LOS and slightly lower 7-day mortality rates.

Conclusion

In this setting, high-acuity EMS arrivals exposed to offload delays did not have prolonged hospital LOS or higher mortality than comparable patients who received timely access.

Contexte

L'engorgement des hôpitaux et des services des urgences (SU) entraîne des retards de déchargement des ambulances et une suspension des services médicaux d'urgence (SMU), en plus de porter atteinte à la prestation de soins. Les séjours prolongés au SU et les retards de prestation de soins aux patients hospitalisés sont associés à une prolongation de la durée de séjour (DS) à l'hôpital et à une augmentation de la mortalité, mais on ne connaît pas très bien les effets des retards de déchargement des ambulances pour cause d'engorgement.

Méthode

Pour ce faire, nous avons utilisé des données administratives pour examiner tous les cas très urgents dont le degré de gravité était de 2 ou 3 sur l’Échelle canadienne de triage et de gravité et qui ont été traités dans l'un des SU pour adultes de Calgary, de juillet 2013 à juin 2016. Les patients qui ont été conduits dans un lieu de prestation de soins en moins de 15 minutes étaient considérés comme des témoins, tandis que ceux qui ont attendu ≥ 60 minutes étaient considérés comme des « sujets en attente». Nous avons eu recours à l'appariement par score de propension pour former des cohortes comparables de témoins et de « sujets en attente ». Le principal critère d’évaluation était la mortalité au bout de 7 jours, et les critères d’évaluation secondaires comprenaient la DS à l'hôpital et la mortalité au bout de 30 jours.

Résultats

Sur 162 002 cas très urgents, 70 711 ont connu une attente ≤ 15 minutes et 41 032, une attente > 60 minutes. Les personnes mises en attente étaient plus susceptibles d’être des femmes âgées, d'avoir un degré de gravité peu élevé au moment du triage, de vivre en état de dépendance et d'arriver les jours de semaine, de jour ou de soir. Les patients en attente avaient besoin moins souvent d’être hospitalisés et, le cas échéant, ils étaient plus susceptibles d’être mutés à l’étage. Les résultats du principal critère d’évaluation étaient comparables dans les deux cohortes; toutefois, les patients en attente ont connu une DS prolongée au SU, mais un taux de mortalité au bout de 7 jours légèrement inférieur à celui enregistré chez les autres patients.

Conclusion

Dans le contexte étudié, les patients arrivés en grande urgence par ambulance et mis en attente n'ont pas connu de séjour plus long à l'hôpital ou un taux de mortalité plus élevé que les patients comparables, traités en temps opportun.

Copyright
Corresponding author
Correspondence to: Dr. Grant Innes, University of Calgary, Department of Emergency Medicine, 416 12 Street NW, Calgary, AB T2N 1Y8; Email: grant.innes@albertahealthservices.ca
References
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Canadian Journal of Emergency Medicine
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  • EISSN: 1481-8035
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