Matching capacity to demand: a regional dashboard reduces ambulance avoidance and improves accessibility of receiving hospitals.
OBJECTIVE
ambulance diversion is a dangerous repercussion of emergency department (ED) crowding and can reflect fragmentation and a lack of coordination in designating optimal patient offload sites for prehospital providers. The objective of this study was to evaluate whether proactive destination selection through the Regional Emergency Patient Access and Coordination (REPAC) program would enhance capacity and ED flow management.


METHODS
the REPAC system provides a dashboard that synthesizes real-time capacity and acuity data for all three adult EDs in the city of Calgary, assigning a color code to reflect receiving status. It assigns destination for the next patient transported by emergency medical services (EMS) by categorizing ED sites as having either a favorable (green/yellow) status or unfavorable (orange/red) status. Three time windows were analyzed: a 6-month window prior to REPAC implementation (pre), the first 6-month window immediately following (post1), and the second 6-month period following (post2). Primary outcomes of interest were the proportion of time spent in favorable versus unfavorable status and EMS avoidances for all adult ED sites in the region (percentage of total time with any center on EMS bypass). Information on total number of ED visits, percentage of patients arriving by EMS transports, admission rates, patient acuity (Canadian Triage and Acuity Score), age, and length of stay (LOS) for admitted and discharged patients was collected. The Kruskal-Wallis test was employed for primary outcome analysis.


RESULTS
implementation of the REPAC system resulted in an increase in the proportion of total time region hospitals reported favorable status (57.5% vs. 64.1%) pre versus post1, an effect that was accentuated at 1 year (post2, 78.7%; p < 0.001 for both comparisons). There was a concomitant decrease in EMS avoidances as a result of the REPAC system, 4.4% to 1.8% (pre vs. post1), also further improved at 1 year to 0.6% (p < 0.001 for both comparisons).


CONCLUSIONS
proactive EMS destination selection through a real-time integrated electronic surveillance system enhances regional capacity and flow management while significantly reducing ambulance diversions.
Division of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada.
Bruce
B
McLeod
Fareen
F
Zaver
Chris
C
Avery
Duane P
DP
Martin
Dongmei
D
Wang
Kim
K
Jessen
Eddy S
ES
Lang
D000416:Alberta; D000552:Ambulances / Q000458:organization & administration*; D000704:Analysis of Variance; D002391:Catchment Area, Health; D003441:Crowding; D016208:Databases, Factual; D004631:Emergency Medical Service Communication Systems / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D009936:Organizational Innovation; D014218:Triage / Q000458:organization & administration