title: Geographic information system data from ambulances applied in the emergency department: effects on patient reception.
abstract: BACKGROUND
  Emergency departments (ED) recognize crowding and handover from prehospital to in-hospital settings to be major challenges. Prehospital Geographical Information Systems (GIS) may be a promising tool to address such issues. In this study, the use of prehospital GIS data was implemented in an ED in order to investigate its effect on 1) wait time and unprepared activations of Trauma Teams (TT) and Medical Emergency Teams (MET) and 2) nurses' perceptions regarding patient reception, workflow and resource utilization.
  
  
  METHODS
  
  
  
  METHODS
  From May 1st 2014 to October 31th 2014, GIS data was displayed in the ED. Data included real-time estimated time of arrival, distance to ED, dispatch criteria, patient data and ambulance contact information. Data was used by coordinating nurses for time activation of TT and MET involved in the initial treatment of severely-injured or critically-ill patients. In addition, it was used as a logistics tool for handling all other patients transported by ambulance to the ED.
  
  
  METHODS
  The study followed a mixed-methods design, consisting of a quantitative study (before and after intervention) and a qualitative study (survey and interviews).
  
  
  METHODS
  Participants included all patients received by TT or MET and coordinating nurses in the ED.
  
  
  RESULTS
  1.) Quantitative: 599 patients were included. The median wait time for TT and MET was 5 min both before and after the GIS intervention, showing no difference (p = 0.18). A significant reduction in the subgroup of waits >10 min was found (p < 0.05). No difference was found in unprepared TT and MET activations. 2.) Qualitative: Nurses perceived GIS data as a tool to optimize resource utilization and quality of all patients' reception, critically or non-critically ill. No substantial disadvantages were reported.
  
  
  CONCLUSIONS
  The contradiction of measured median wait time and nurses perceived improved timing of team activation may result from having both RT- ETA and supplemental patient information not only for seriously-injured or critically-ill patients received by the TT and MET, but for all patients transported by ambulance. The reduction in waits > 10 minutes may have contributed to the overall perception of reduced wait time, as avoidance of long waits is clinically more important than reduction in the median wait time.
  
  
  CONCLUSIONS
  A comparison of the use of prehospital GIS data in the ED with the control period showed no effect on median wait time for TT and MET, however, the number of waits of >10 min was reduced. On the other hand, nurses perceived implementation of GIS data as improving workflow, resource utilization and quality of all patients' reception, critically as well as non-critically ill. There were no substantial disadvantages to the GIS application.
  
  
  BACKGROUND
  ClinicalTrials.gov (NCT02188966).
authors.affiliation: Research Department, Prehospital Emergency Medical Services, Central Denmark Region, Olof Palmes Alle 34, Aarhus N, DK-8200, Denmark. nikoraab@rm.dk.|Research Center for Emergency Medicine, Aarhus University Hospital, Noerrebrogade 44, build. 30, Aarhus C, DK 8000, Denmark. nikoraab@rm.dk.|Emergency Department, Aarhus University Hospital, Norrebrogade 44, Aarhus C, DK-8000, Denmark. nikoraab@rm.dk.
authors.forename: Nikolaj
authors.initials: N
authors.lastname: Raaber
authors.affiliation: Interdisciplinary Centre for Organizational Architecture (ICOA), Business and Social Sciences, Aarhus University, Bartholins Allé 12, Aarhus C, DK-8000, Denmark.|Emergency Department, Aarhus University Hospital, Norrebrogade 44, Aarhus C, DK-8000, Denmark.
authors.forename: Iben
authors.initials: I
authors.lastname: Duvald
authors.affiliation: Research Department, Prehospital Emergency Medical Services, Central Denmark Region, Olof Palmes Alle 34, Aarhus N, DK-8200, Denmark.
authors.forename: Ingunn
authors.initials: I
authors.lastname: Riddervold
authors.affiliation: Clinical Institute, Aalborg University, Sdr. Skovvej 15, Aalborg, DK-9000, Denmark.|Department of Anesthesiology and intensive care medicine, Aalborg University Hospital, Hobrovej 18-20, Aalborg, DK-9000, Denmark.
authors.forename: Erika F
authors.initials: EF
authors.lastname: Christensen
authors.affiliation: Research Center for Emergency Medicine, Aarhus University Hospital, Noerrebrogade 44, build. 30, Aarhus C, DK 8000, Denmark.
authors.forename: Hans
authors.initials: H
authors.lastname: Kirkegaard
mesh_terms: D000552:Ambulances; D003441:Crowding; D003718:Denmark; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital; D040362:Geographic Information Systems; D006801:Humans; D007407:Interviews as Topic; D036301:Qualitative Research; D011795:Surveys and Questionnaires
keywords: Emergency department nursing; Emergency department organization; GIS data; Medical emergency team activation; Telemedicine; Trauma team activation