Differences between cases admitted to hospital and discharged from the emergency department after emergency medical services transport
Objective Rising emergency medical services (EMS) utilisation increases transport to hospital emergency departments (ED). However, some patients receive outpatient treatment (discharged) while others are hospitalised (admitted). The aims of this analysis were to compare admitted and discharged cases...
Saved in:
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2019-09-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/9/e030636.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850066562756640768 |
|---|---|
| author | Kathrin Hegenberg Heiko Trentzsch Stephan Prückner |
| author_facet | Kathrin Hegenberg Heiko Trentzsch Stephan Prückner |
| author_sort | Kathrin Hegenberg |
| collection | DOAJ |
| description | Objective Rising emergency medical services (EMS) utilisation increases transport to hospital emergency departments (ED). However, some patients receive outpatient treatment (discharged) while others are hospitalised (admitted). The aims of this analysis were to compare admitted and discharged cases, to assess whether cases that were discharged from the ED could be identified using dispatch data and to compare dispatch keyword categories and hospital diagnoses.Design Retrospective observational study using linked secondary data.Setting and participants 78 303 cases brought to 1 of 14 ED in the city of Munich, Germany, by EMS between 1 July 2013 and 30 June 2014.Main outcome measures Characteristics of admitted and discharged cases were assessed. Logistic regression was used to estimate the association between discharge and age, sex, time of day, ambulance type and dispatch keyword category. Keyword categories were compared to hospital diagnoses.Results 39.4% of cases were discharged. They were especially likely to be young (OR 10.53 (CI 9.31 to 11.92), comparing <15-year-olds to >70-year-olds) and to fall under the categories ‘accidents/trauma’ (OR 2.87 (CI 2.74 to 3.01)) or ‘other emergencies (unspecified)’ (OR 1.23 (CI 1.12 to 1.34) (compared with ‘cardiovascular’). Most frequent diagnoses came from chapter ‘injury and poisoning’ (30.1%) of the 10th revision of the international statistical classification of disease and related health problems (ICD-10), yet these diagnoses were more frequent at discharge (42.7 vs 22.0%) whereas circulatory system disease was less frequent (2.6 vs 21.8%). Except for accidents/trauma and intoxication/poisoning many underlying diagnoses were observed for the same dispatch keyword.Conclusion Young age and dispatch for accidents or trauma were the strongest predictors of discharge. Even within the same dispatch keyword category the distribution of diagnoses differed between admitted and discharged cases. Discharge from the ED does not indicate that urgent response was unnecessary. However, these cases could be suitable for allocation to hospitals with low inpatient bed capacities and are of particular interest for future studies regarding the urgency of their condition. |
| format | Article |
| id | doaj-art-c8770b069a554ce59cefa0afebf25cd8 |
| institution | DOAJ |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-c8770b069a554ce59cefa0afebf25cd82025-08-20T02:48:42ZengBMJ Publishing GroupBMJ Open2044-60552019-09-019910.1136/bmjopen-2019-030636Differences between cases admitted to hospital and discharged from the emergency department after emergency medical services transportKathrin Hegenberg0Heiko Trentzsch1Stephan Prückner2Institut für Notfallmedizin und Medizinmanagement, Ludwig-Maximilians-Universitat München, Klinikum der Universität München, Munchen, GermanyInstitut für Notfallmedizin und Medizinmanagement, Ludwig-Maximilians-Universitat München, Klinikum der Universität München, Munchen, GermanyInstitut für Notfallmedizin und Medizinmanagement, Ludwig-Maximilians-Universitat München, Klinikum der Universität München, Munchen, GermanyObjective Rising emergency medical services (EMS) utilisation increases transport to hospital emergency departments (ED). However, some patients receive outpatient treatment (discharged) while others are hospitalised (admitted). The aims of this analysis were to compare admitted and discharged cases, to assess whether cases that were discharged from the ED could be identified using dispatch data and to compare dispatch keyword categories and hospital diagnoses.Design Retrospective observational study using linked secondary data.Setting and participants 78 303 cases brought to 1 of 14 ED in the city of Munich, Germany, by EMS between 1 July 2013 and 30 June 2014.Main outcome measures Characteristics of admitted and discharged cases were assessed. Logistic regression was used to estimate the association between discharge and age, sex, time of day, ambulance type and dispatch keyword category. Keyword categories were compared to hospital diagnoses.Results 39.4% of cases were discharged. They were especially likely to be young (OR 10.53 (CI 9.31 to 11.92), comparing <15-year-olds to >70-year-olds) and to fall under the categories ‘accidents/trauma’ (OR 2.87 (CI 2.74 to 3.01)) or ‘other emergencies (unspecified)’ (OR 1.23 (CI 1.12 to 1.34) (compared with ‘cardiovascular’). Most frequent diagnoses came from chapter ‘injury and poisoning’ (30.1%) of the 10th revision of the international statistical classification of disease and related health problems (ICD-10), yet these diagnoses were more frequent at discharge (42.7 vs 22.0%) whereas circulatory system disease was less frequent (2.6 vs 21.8%). Except for accidents/trauma and intoxication/poisoning many underlying diagnoses were observed for the same dispatch keyword.Conclusion Young age and dispatch for accidents or trauma were the strongest predictors of discharge. Even within the same dispatch keyword category the distribution of diagnoses differed between admitted and discharged cases. Discharge from the ED does not indicate that urgent response was unnecessary. However, these cases could be suitable for allocation to hospitals with low inpatient bed capacities and are of particular interest for future studies regarding the urgency of their condition.https://bmjopen.bmj.com/content/9/9/e030636.full |
| spellingShingle | Kathrin Hegenberg Heiko Trentzsch Stephan Prückner Differences between cases admitted to hospital and discharged from the emergency department after emergency medical services transport BMJ Open |
| title | Differences between cases admitted to hospital and discharged from the emergency department after emergency medical services transport |
| title_full | Differences between cases admitted to hospital and discharged from the emergency department after emergency medical services transport |
| title_fullStr | Differences between cases admitted to hospital and discharged from the emergency department after emergency medical services transport |
| title_full_unstemmed | Differences between cases admitted to hospital and discharged from the emergency department after emergency medical services transport |
| title_short | Differences between cases admitted to hospital and discharged from the emergency department after emergency medical services transport |
| title_sort | differences between cases admitted to hospital and discharged from the emergency department after emergency medical services transport |
| url | https://bmjopen.bmj.com/content/9/9/e030636.full |
| work_keys_str_mv | AT kathrinhegenberg differencesbetweencasesadmittedtohospitalanddischargedfromtheemergencydepartmentafteremergencymedicalservicestransport AT heikotrentzsch differencesbetweencasesadmittedtohospitalanddischargedfromtheemergencydepartmentafteremergencymedicalservicestransport AT stephanpruckner differencesbetweencasesadmittedtohospitalanddischargedfromtheemergencydepartmentafteremergencymedicalservicestransport |