title: Effect of the number of request calls on the time from call to hospital arrival: a cross-sectional study of an ambulance record database in Nara prefecture, Japan.
abstract: In Japan, ambulance staff sometimes must make request calls to find hospitals that can accept patients because of an inadequate information sharing system. This study aimed to quantify effects of the number of request calls on the time interval between an emergency call and hospital arrival.
  
  
  
  A cross-sectional study of an ambulance records database in Nara prefecture, Japan.
  
  
  
  A total of 43 663 patients (50% women; 31.2% aged 80 years and over): (1) transported by ambulance from April 2013 to March 2014, (2) aged 15 years and over, and (3) with suspected major illness.
  
  
  
  The time from call to hospital arrival, defined as the time interval from receipt of an emergency call to ambulance arrival at a hospital.
  
  
  
  The mean time interval from emergency call to hospital arrival was 44.5 min, and the mean number of requests was 1.8. Multilevel linear regression analysis showed that ∼43.8% of variations in transportation times were explained by patient age, sex, season, day of the week, time, category of suspected illness, person calling for the ambulance, emergency status at request call, area and number of request calls. A higher number of request calls was associated with longer time intervals to hospital arrival (addition of 6.3 min per request call; p<0.001). In an analysis dividing areas into three groups, there were differences in transportation time for diseases needing cardiologists, neurologists, neurosurgeons and orthopaedists.
  
  
  
  The study revealed 6.3 additional minutes needed in transportation time for every refusal of a request call, and also revealed disease-specific delays among specific areas. An effective system should be collaboratively established by policymakers and physicians to ensure the rapid identification of an available hospital for patient transportation in order to reduce the time from the initial emergency call to hospital arrival.
authors.affiliation: Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan.
authors.forename: Nao
authors.initials: N
authors.lastname: Hanaki
authors.affiliation: Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan.
authors.forename: Kazuto
authors.initials: K
authors.lastname: Yamashita
authors.affiliation: Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Kunisawa
authors.affiliation: Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Imanaka
mesh_terms: D000552:Ambulances / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D004631:Emergency Medical Service Communication Systems / Q000592:standards*; D004632:Emergency Medical Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D007564:Japan; D012044:Regression Analysis
keywords: ambulance transportation; emergency medical service; request call; transportation time