Factors associated with difficulty of hospital acceptance of patients suspected to have cerebrovascular diseases: A nationwide population-based observational study

Abstract

Although it is essential to shorten the interval to initial treatment in the care of acute ischemic stroke, some hospitals in Japan reject requests for hospital acceptance from on-scene emergency medical service personnel because of limited resources, which can cause delays in care. We aimed to assess the risk factors for difficulty of hospital acceptance of patients suspected to have cerebrovascular diseases. We conducted a retrospective analysis of the national ambulance records of the Fire and Disaster Management Agency in Japan in 2016. Multivariable logistic regression analysis was used to assess the association between difficulty of hospital acceptance of patients suspected to have cerebrovascular diseases and prehospital factors. During the study period, a total of 222,926 patients were included, and 5283 patients (2.4%) experienced difficulties in hospital acceptance. In multivariable analysis, nights (adjusted odds ratio [AOR] 1.54, 95% confidence interval [CI] 1.45–1.64), weekends (AOR 1.32, 95% CI 1.24–1.40), <25 percentile ratio of emergency physicians and neurosurgeons to all physicians (AOR 1.13, 95% CI 1.03–1.23) (AOR 1.36, 95% CI 1.25–1.48), and mean age of physicians (AOR 1.06, 95% CI 1.05–1.07) were significantly associated with difficulties of hospital acceptance of patients suspected to have cerebrovascular disease. There was a marked regional variation in the difficulties of hospital acceptance. Among the national ambulance records of patients suspected to have cerebrovascular diseases, certain prehospital factors such as weekends were positively associated with difficulty of hospital acceptance. A comprehensive strategy for hospital acceptance of patients with cerebrovascular diseases considering regional variation is required.

Impact of increased reimbursement for ambulance transportation on hospital acceptance in Japan: a difference-in-difference study

“…This outcome could be attributed to the financial incentives hospitals received with reimbursement for ambulance transportation acceptance, and it could be an effective solution for the difficulties associated with hospital acceptance in Japan. Previous studies reported that older patient age, night-time and weekends were associated with difficulty in hospital acceptance in Japan 6 8 10. Increasing the reimbursement for ambulance transportation acceptance might be an effective solution to these difficulties.…”

“…In particular, our results showed that an increase in the reimbursement for ambulance transportation acceptance decreased the number of EMS calls for severe and moderate patients, which is more important in emergency medicine. In addition, the findings showed a trend toward effectiveness in the Kansai region, where the emergency room system is generally fragile and hospitals have more difficulty accepting patients, which indicates that providing financial support to accepting hospitals would be one of the possible solutions for addressing the difficulty in hospital acceptance, especially in areas where the medical system is already overstretched 8…”

“…If patients were not likely to require hospitalisation, they were categorised as mild. Location was classified into five categories: home, public space, workplace, road and others 8. The types of incidents were classified into 10 categories: diseases, fire accidents, natural disasters, water-related accidents, motor vehicle accidents, industrial accidents, sports-related accidents, falls and other injuries, assault and self-inflicted injuries 17.…”

“…It is caused by the increasing number of ambulance dispatches, the lack of emergency medical resources in each hospital and a unique emergency medicine system in Japan 4 5. In the Japanese emergency medicine system, physicians working in hospital EDs can decide whether to accept a transport request from emergency medical service (EMS) personnel 6–8. In fact, EDs often decline patients due to limited resources, such as unavailability of hospital beds or absence of suitable specialists to treat the patient’s symptoms 4.…”

“…4 5 In the Japanese emergency medicine system, physicians working in hospital EDs can decide whether to accept a transport request from emergency medical service (EMS) personnel. [6][7][8] In fact, EDs often decline patients due to limited resources, such as unavailability of hospital beds or absence of suitable specialists to treat the patient's symptoms. 4 One criterion used by the Fire and Disaster Management Agency (FDMA) to define difficulty in hospital acceptance is ≥4 phone calls by EMS personnel to hospitals until the patient is accepted.…”