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

Abstract

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 (IQR 21–38). 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.