Factors associated with the difficulty in hospital acceptance at the scene by emergency medical service personnel: a population-based study in Osaka City, Japan

Katayama, Yusuke; Kitamura, Tetsuhisa; Kiyohara, Kosuke; Iwami, Taku; Kawamura, Takashi; Hayashida, Sumito; Yoshiya, Kazuhisa; Ogura, Hiroshi; Shimazu, Takeshi

doi:10.1136/bmjopen-2016-013849

Cited by 39 publications

(82 citation statements)

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“…In the Senshu medical control area in Osaka, Japan, Nakao and colleagues reported descriptive results of all emergency patients for whom fire departments had selected medical institutions, but they pointed out that there were excessive limitations to registering them when using a handwritten‐based registry . In contrast, multicenter registry research has been undertaken with the use of information technology, and the establishment of databases that linked ambulance records with in‐hospital information has been also achieved in some areas . Importantly, however, most of these databases were hospital‐based, and there were few population‐based registries at the regional or national level.…”

Section: Introductionmentioning

confidence: 99%

Profile of the ORION (Osaka emergency information Research Intelligent Operation Network system) between 2015 and 2016 in Osaka, Japan: a population‐based registry of emergency patients with both ambulance and in‐hospital records

Okamoto

Katayama

Kitamura

et al. 2018

Acute Medicine & Surgery

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AimTo describe the registry design of the Osaka Emergency Information Research Intelligent Operation Network system (ORION) and its profile of hospital information, patient and emergency medical service characteristics, and in‐hospital outcomes among all patients transported to critical care centers and emergency hospitals in Osaka Prefecture, Japan.MethodsThe Osaka Prefecture Government has developed and introduced an information system for emergency patients (the ORION system) that uses a smartphone application (app) for hospital selection by on‐scene emergency medical service personnel and has been accumulating all ambulance records. Since January 2015, medical institutions have obtained information on the diagnosis and outcome of patients transported to medical institutions, and the ORION system merged these data with ambulance records including smartphone app data.ResultsFrom January 2015 to December 2016, 753,301 eligible patients were registered. The mean age was 58.7 years, and 51.5% of patients were male. After hospital arrival, 39.7% were hospitalized, 58.2% were discharged from hospital, 1.1% changed hospital, and 1.0% died. The most common diagnoses were injury, poisoning, and certain other consequences of external causes. Among the hospitalized patients, 29.2% were continuously hospitalized, 59.0% discharged, 5.2% changed hospital, and 5.8% were dead at 21 days after hospitalization. The most common confirmed diagnosis was diseases of the circulatory system.ConclusionUsing the ORION system developed and operated by Osaka Prefecture since January 2015, we described the epidemiological data of all emergency patients transported to emergency hospitals. Analysis using the ORION database in the future could lead to improvements in the emergency transport system and patient outcomes.

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Section: Introductionmentioning

confidence: 99%

Profile of the ORION (Osaka emergency information Research Intelligent Operation Network system) between 2015 and 2016 in Osaka, Japan: a population‐based registry of emergency patients with both ambulance and in‐hospital records

Okamoto

Katayama

Kitamura

et al. 2018

Acute Medicine & Surgery

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Section: Discussionmentioning

confidence: 99%

“…A previous study found that hospital acceptance of patients depends on patient characteristics such as age, citizenship status, level of consciousness, the presence of drug abuse, gas poisoning, or self-induced trauma 10) . This study also demonstrated that holiday/weekends or night-times were associated with difficulty in hospital acceptance 10) . A separate study of patients with traumatic injuries demonstrated that pediatric patients, moderate to severe trauma, holiday/weekends or night-times were also associated with difficulty in hospital acceptance 11) .…”

Section: Discussionmentioning

confidence: 99%

“…Other emergency centers operate with limited resources such as on-call surgeons or on-call internists, which in turn limits the scope of patients that can be accepted from emergency medical services (EMS) transports 8) . This combination of tertiary and limited non-tertiary centers leads to inefficiency, diversion, and delayed care [9][10][11] . The increased burden of elderly emergency patients and risk of lawsuits have also caused numerous issues 9) .…”

Section: Introductionmentioning

confidence: 99%

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Factors Associated with Longer Transportation Time to North American Style Emergency Department in Japan

Shiga

Taira

Taira³

et al. 2019

J St. Marianna Univ

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Japanese emergency departments have traditionally been separated into tertiary and secondary centers. Tertiary emergency centers focus on the care of trauma and critically ill patients, while secondary emergency centers operate with limited resources and only accept patients of a limited acuity from emergency medical services (EMS). In contrast, North American-style Emergency Departments (NAED) have been developed, with the aim of accepting both critical and non-critical patients. We conducted a retrospective, observational study using municipal EMS records from 2012 in a Japanese city. Our aim was to identify patient characteristics associated with long EMS transportation times to NAED in an urban city where both traditional and NAED centers are available. The primary endpoint was long transportation time, defined as >35 minutes. Other items included the distance of transportation from the scene (km), age, sex, reason for transportation (medical or surgical), relevant specialty determined by EMS, condition severity, number of EMS negotiations until acceptance, and the reason for diversion by other hospitals. Multivariate logistic regression was used to find characteristics associated with long transportation time. A total of 2934 patients were included in the analysis. Median transportation time was 29 minutes . Characteristics that were associated with long transportation time included age (years) (OR, 1.02; 95%CI, 1.02-1.03; P<0.01), patients with orthopedic (OR, 1.69; 95%CI, 1.08-2.66; P=0.02) or neurosurgical (OR, 1.72; 95%CI, 1.21-2.47; P<0.01) conditions, and the number of EMS negotiations until acceptance (OR, 4.08; 95%CI, 3.12-5.33; P<0.01). Long transportation times were negatively associated with patients with medical (OR, 0.66; 95%CI, 0.46-0.96; P=0.03) and ear nose and throat (ENT) (OR, 0.13; 95%CI, 0.04-0.44; P<0.01) conditions. This is likely because the NAEDs fill an unmet need for patients that require certain types of care, such as surgical or neurosurgical treatment, or because they accept patients that have been refused by other centers.

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“…The EMS system is basically the same as that used in other areas of Japan, as previously described. 21 In Osaka Prefecture, EMS systems such as ambulance dispatch systems are operated by each local government, and ambulances are dispatched by calling 1-1-9. In 2016, the EMS system was operated by 27 re departments (298 ambulances) and 24 re control stations.…”

Section: Ems System and Hospitals In Osaka Prefecture And Japanmentioning

confidence: 99%

Factors Associated with Prolonged Hospitalization Among Patients Transported by Emergency Medical Services: A Population-based Study in Osaka, Japan

Katayama¹,

Kitamura²,

Tanaka³

et al. 2020

Preprint

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Background The emergency medical system, one of the essential elements of public health, has been around for more than 50 years. Although many studies have assessed the factors associated with overcrowding and prolonged length of stay in emergency departments, whether the clinical characteristics and background of a patient are associated with prolonged hospitalization among patients transported by ambulance is unknown. The purpose of this study was to reveal factors associated with the continuation of hospitalization at 21 days after hospital admission among patients transported by ambulance using a population-based patient registry in Osaka, Japan. Method: This was a retrospective observational study whose study period was the three years from January 2016 to December 2018. In this study, we included patients who were hospitalized after transportation by ambulance as determined using cleaned data that was recorded in the ORION system. The main outcome was continuation of hospitalization at 21 days after hospital admission. We calculated the adjusted odds ratios (AOR) and 95% confidence interval (CI) with a multivariable logistic regression model to assess factors associated with the outcome. Results We included 481,886 patients in this study, of whom 158,551 remained hospitalized at 21 days after hospital admission and 323,335 had been discharged home by 21 days after hospital admission. Factors associated with prolonged hospitalization were elderly (AOR: 1.767 [95% CI: 1.730–1.805]), traffic accident (AOR: 1.231 [95% CI: 1.183–1.282]), no fixed address (AOR: 4.494 [95% CI: 3.632–5.314]), need for nursing care (AOR: 1.420 [95% CI: 1.397–1.443]) and solitary person (AOR: 1.085 [95% CI: 1.050–1.120]). Conclusion In this study, the elderly, traffic accidents, no fixed address, need for nursing care, and solitary person were the factors associated with prolonged hospitalization of patients transported by ambulance in Japan.

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Factors associated with the difficulty in hospital acceptance at the scene by emergency medical service personnel: a population-based study in Osaka City, Japan

Cited by 39 publications

References 13 publications

Profile of the ORION (Osaka emergency information Research Intelligent Operation Network system) between 2015 and 2016 in Osaka, Japan: a population‐based registry of emergency patients with both ambulance and in‐hospital records

Profile of the ORION (Osaka emergency information Research Intelligent Operation Network system) between 2015 and 2016 in Osaka, Japan: a population‐based registry of emergency patients with both ambulance and in‐hospital records

Factors Associated with Longer Transportation Time to North American Style Emergency Department in Japan

Factors Associated with Prolonged Hospitalization Among Patients Transported by Emergency Medical Services: A Population-based Study in Osaka, Japan

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