The impact of an ambulance destination policy change on emergency department care metrics in New York City.
The American journal of emergency medicine · 2026-06-04 · Quasi-experimental
Abstract
STUDY OBJECTIVE: In March 2025, the Fire Department of New York implemented a policy directing EMS to transport patients to hospitals assigned by computer-aided dispatch, typically the nearest facility. This replaced the prior policy allowing transport to a nearby hospital within a 10-min drive based on patient preference. We evaluated the policy's impact on emergency department (ED) operations across New York City Health + Hospitals, the largest public health system in the United States. METHODS: This retrospective, multicenter study included all ED visits across NYC H + H hospitals from April 1-August 30, 2024 (pre-implementation) and April 1-August 30, 2025 (post-implementation). Primary outcomes were time-to-clinician, triage-to-disposition decision time (length of stay, LOS), leaving without being seen (LWBS), daily ED volume, interfacility transfers, and boarding time. Mann-Whitney tests were used for univariate comparisons. Regression models adjusted for site effects compared outcomes between periods. RESULTS: Among 943,658 ED visits (481,260 pre; 462,398 post), the geometric mean time-to-clinician decreased by 16.4% (15 to 12 min; 95% CI, 15.8-16.9%). ED LOS decreased by 1% (151 to 149 min; 95% CI, 0.7-1.6%). LWBS declined from 0.9% to 0.7%. Mean daily ED volume decreased from 286 to 275 visits. Interfacility transfers increased slightly (0.34% to 0.35%) but were not statistically significant. Boarding times were unchanged (141 vs 140 min). CONCLUSION: EMS destination policies can affect ED care delivery metrics. As such, stakeholders and policymakers should remain mindful of these downstream effects and incorporate patient-centered considerations when planning and implementing policy changes.