Outpatient care in acute and prehospital emergency medicine by emergency medical and patient transport service over a 10-year period: a retrospective study based on dispatch data from a German emergency medical dispatch centre (OFF-RESCUE).
BMC Emergency Medicine · 2021-03-09 · Registry study
Abstract
BACKGROUND: The number of operations by the German emergency medical service almost doubled between 1994 and 2016. The associated expenses increased by 380% in a similar period. Operations with treatment on-site, which retrospectively proved to be misallocated (OFF-Missions), have a substantial proportion of the assignment of the emergency medical service (EMS). Besides OFF-Missions, operations with patient transport play a dominant role (named as ON-Missions). The aim of this study is to work out the medical and economic relevance of both operation types. METHODS: This analysis examined N = 819,780 missions of the EMS and patient transport service (PTS) in the catchment area of the emergency medical dispatch centre (EMDC) Bad Kreuznach over the period from 01/01/2007 to 12/31/2016 in terms of triage and disposition, urban-rural distribution, duration of operations and economic relevance (p < .01). RESULTS: 53.4% of ON-Missions are triaged with the indication non-life-threatening patient transport; however, 63.7% are processed by the devices of the EMS. Within the OFF-Mission cohort, 78.2 and 85.8% are triaged or dispatched for the EMS. 74% of all ON-Missions are located in urban areas, 26% in rural areas; 81.3% of rural operations are performed by the EMS. 66% of OFF-Missions are in cities. 93.2% of the remaining 34% of operations in rural locations are also performed by the EMS. The odds for both ON- and OFF-Missions in rural areas are significantly higher than for PTS (ORON 3.6, 95% CI 3.21-3.30; OROFF 3.18, 95% CI 3.04-3.32). OFF-Missions last 47.2 min (SD 42.3; CI 46.9-47.4), while ON-Missions are processed after 79.7 min on average (SD 47.6; CI 79.6-79.9). ON-Missions generated a turnover of more than € 114 million, while OFF-Missions made a loss of almost € 13 million. CONCLUSIONS: This study particularly highlights the increasing utilization of emergency devices; especially in OFF-Missions, the resources of the EMS have a higher number of operations than PTS. OFF-Missions cause immensely high costs due to misallocations from an economic point of view. Appropriate patient management appears necessary from both medical and economic perspective, which requires multiple solution approaches.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Cost & cost-effectiveness · Rural & remote · Time intervals · Urban
Related articles
- Emergency services utilization in Jakarta (Indonesia): a cross-sectional study of patients attending hospital emergency departments. (BMC Health Serv Res, 2022)
- Remoteness and emergency care pathways for ambulance-attended atrial fibrillation: a population-based linked cohort study. (Int J Cardiol Heart Vasc, 2026)
- Disparities in Emergency Medical Services Time Intervals for Patients with Suspected Acute Coronary Syndrome: Findings from the North Carolina Prehospital Medical Information System. (J Am Heart Assoc, 2021)
- Prehospital Trauma Scene and Transport Times for Pediatric and Adult Patients. (West J Emerg Med, 2020)
- Identifying the vulnerable regions of emergency medical services based on the three-stage of accessibility: a case study in Xi'an, China. (Int J Equity Health, 2022)
- Prehospital evaluation and economic analysis of different coronary syndrome treatment strategies--PREDICT--rationale, development and implementation. (BMC Emerg Med, 2011)