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Clinical and economic factors associated with ambulance use to the emergency department.
Acad Emerg Med. 2006 Aug; 13(8):879-85.AE

Abstract

BACKGROUND

Concern about ambulance diversion and emergency department (ED) overcrowding has increased scrutiny of ambulance use. Knowledge is limited, however, about clinical and economic factors associated with ambulance use compared to other arrival methods.

OBJECTIVES

To compare clinical and economic factors associated with different arrival methods at a large, urban, academic hospital ED.

METHODS

This was a retrospective, cross-sectional study of all patients seen during 2001 (N = 80,209) at an urban academic hospital ED. Data were obtained from hospital clinical and financial records. Outcomes included acuity and severity level, primary complaint, medical diagnosis, disposition, payment, length of stay, costs, and mode of arrival (bus, car, air-medical transport, walk-in, or ambulance). Multivariate logistic regression identified independent factors associated with ambulance use.

RESULTS

In multivariate analysis, factors associated with ambulance use included: triage acuity A (resuscitation) (adjusted odds ratio [OR], 51.3; 95% confidence interval [CI] = 33.1 to 79.6) or B (emergent) (OR, 9.2; 95% CI = 6.1 to 13.7), Diagnosis Related Group severity level 4 (most severe) (OR, 1.4; 95% CI = 1.2 to 1.8), died (OR, 3.8; 95% CI = 1.5 to 9.0), hospital intensive care unit/operating room admission (OR, 1.9; 95% CI = 1.6 to 2.1), motor vehicle crash (OR, 7.1; 95% CI = 6.4 to 7.9), gunshot/stab wound (OR, 2.1; 95% CI = 1.5 to 2.8), fell 0-10 ft (OR, 2.0; 95% CI = 1.8 to 2.3). Medicaid Traditional (OR, 2.0; 95% CI = 1.4 to 2.4), Medicare Traditional (OR, 1.8; 95% CI = 1.7 to 2.1), arrived weekday midnight-8 am (OR, 2.0; 95% CI = 1.8 to 2.1), and age > or =65 years (OR, 1.3; 95% CI = 1.2 to 1.5).

CONCLUSIONS

Ambulance use was related to severity of injury or illness, age, arrival time, and payer status. Patients arriving by ambulance were more likely to be acutely sick and severely injured and had longer ED length of stay and higher average costs, but they were less likely to have private managed care or to leave the ED against medical advice, compared to patients arriving by independent means.

Authors+Show Affiliations

Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT 06520, USA. Jennifer.ruger@yale.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

16825670

Citation

Ruger, Jennifer Prah, et al. "Clinical and Economic Factors Associated With Ambulance Use to the Emergency Department." Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, vol. 13, no. 8, 2006, pp. 879-85.
Ruger JP, Richter CJ, Lewis LM. Clinical and economic factors associated with ambulance use to the emergency department. Acad Emerg Med. 2006;13(8):879-85.
Ruger, J. P., Richter, C. J., & Lewis, L. M. (2006). Clinical and economic factors associated with ambulance use to the emergency department. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 13(8), 879-85.
Ruger JP, Richter CJ, Lewis LM. Clinical and Economic Factors Associated With Ambulance Use to the Emergency Department. Acad Emerg Med. 2006;13(8):879-85. PubMed PMID: 16825670.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical and economic factors associated with ambulance use to the emergency department. AU - Ruger,Jennifer Prah, AU - Richter,Christopher J, AU - Lewis,Lawrence M, Y1 - 2006/07/06/ PY - 2006/7/11/pubmed PY - 2006/10/28/medline PY - 2006/7/11/entrez SP - 879 EP - 85 JF - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine JO - Acad Emerg Med VL - 13 IS - 8 N2 - BACKGROUND: Concern about ambulance diversion and emergency department (ED) overcrowding has increased scrutiny of ambulance use. Knowledge is limited, however, about clinical and economic factors associated with ambulance use compared to other arrival methods. OBJECTIVES: To compare clinical and economic factors associated with different arrival methods at a large, urban, academic hospital ED. METHODS: This was a retrospective, cross-sectional study of all patients seen during 2001 (N = 80,209) at an urban academic hospital ED. Data were obtained from hospital clinical and financial records. Outcomes included acuity and severity level, primary complaint, medical diagnosis, disposition, payment, length of stay, costs, and mode of arrival (bus, car, air-medical transport, walk-in, or ambulance). Multivariate logistic regression identified independent factors associated with ambulance use. RESULTS: In multivariate analysis, factors associated with ambulance use included: triage acuity A (resuscitation) (adjusted odds ratio [OR], 51.3; 95% confidence interval [CI] = 33.1 to 79.6) or B (emergent) (OR, 9.2; 95% CI = 6.1 to 13.7), Diagnosis Related Group severity level 4 (most severe) (OR, 1.4; 95% CI = 1.2 to 1.8), died (OR, 3.8; 95% CI = 1.5 to 9.0), hospital intensive care unit/operating room admission (OR, 1.9; 95% CI = 1.6 to 2.1), motor vehicle crash (OR, 7.1; 95% CI = 6.4 to 7.9), gunshot/stab wound (OR, 2.1; 95% CI = 1.5 to 2.8), fell 0-10 ft (OR, 2.0; 95% CI = 1.8 to 2.3). Medicaid Traditional (OR, 2.0; 95% CI = 1.4 to 2.4), Medicare Traditional (OR, 1.8; 95% CI = 1.7 to 2.1), arrived weekday midnight-8 am (OR, 2.0; 95% CI = 1.8 to 2.1), and age > or =65 years (OR, 1.3; 95% CI = 1.2 to 1.5). CONCLUSIONS: Ambulance use was related to severity of injury or illness, age, arrival time, and payer status. Patients arriving by ambulance were more likely to be acutely sick and severely injured and had longer ED length of stay and higher average costs, but they were less likely to have private managed care or to leave the ED against medical advice, compared to patients arriving by independent means. SN - 1553-2712 UR - https://www.unboundmedicine.com/medline/citation/16825670/Clinical_and_economic_factors_associated_with_ambulance_use_to_the_emergency_department_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1069-6563&date=2006&volume=13&issue=8&spage=879 DB - PRIME DP - Unbound Medicine ER -