Title: The Impact of a New Freestanding Emergency Department on a County Emergency Medical Services System
Abstract: Freestanding emergency departments (FEDs) are increasing throughout the United States, but their effect on the efficiency of surrounding emergency medical services (EMS) systems has not been well studied. This study evaluates the impact of a new FED on the efficiency of a county EMS system. A new FED, Queen Anne's County Emergency Center (QAEC), opened on 10/4/2010 to serve a primarily rural area of Maryland's Eastern Shore region where the closest hospital is 20 miles away. The study population included all patients transported by the Queen Anne's County EMS system from 4/4/2010 to 10/3/2011. Data from the county's computer assisted dispatch (CAD) system of all ambulance calls were obtained. Efficiency metrics were calculated 6 months prior to the opening of QAEC (pre-intervention: April 4, 2010 to October 3, 2010), and 6 months after a wash-out period (post-intervention: April 4, 2011 to October 3, 2011). Although there is no formal, standardized definition of EMS time intervals, we adapted previous models to reflect the EMS system and geography of the region. These time intervals were calculated from the out-of-hospital records and included the out-of-service interval (our primary outcome measure), defined as the period from alarm to back in service. Secondary outcome measures included the response interval defined as the period from alarm to arrival on scene, the turnaround time defined as the period from arrival at the hospital to back in service, and the transport interval defined as the period from leaving the scene to arrival at the hospital. These intervals were all calculated as lengths of time and averaged over the two study phases (pre- and post-intervention). The significance of these values was then determined with a two-tailed t-test. Prior to the opening of QAEC there were an average of 10.4 (Standard Deviation (SD) 2.8) transports per day and in the post-intervention period an average of 9.4 (SD 3.5) transports per day by EMS (p<0.001). Over the time period evaluated, there was a statistically significant decrease in the out-of-service interval, with a pre-intervention mean out-of-service time of 87.3 (SD 27.6) minutes while post-intervention 81.1 (SD 28.9) minutes (p<0.0001). On analysis of our secondary outcomes, response intervals were not found to be significantly changed for first vehicle on scene (pre-intervention 7.8 (SD 27.6) minutes; post-intervention 8.3 (SD 29.2) minutes; p 0.81) or for first transport vehicle on scene (pre-intervention 7.6 (SD 4.7) minutes; post-intervention 7.9 (SD 4.7) minutes; p 0.46); however, turnaround intervals and transport intervals were decreased with statistical significance. The turnaround time decreased from a pre-intervention time of 26.8 (SD 14.4) minutes to post-intervention 25.1 (SD 16.0) minutes (p<0.0001). The transport interval also decreased from pre-intervention 22.2 (SD 10.5) minutes to post-intervention 19.9 (SD 11.0) minutes (p<0.0001). A new FED allowed a closer location for ambulance and walk-in emergency department patients. This improved access increased the efficiency of the EMS system as measured by decreased overall out-of-service times in a rural county.
Publication Year: 2013
Publication Date: 2013-10-01
Language: en
Type: article
Indexed In: ['crossref']
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Cited By Count: 1
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