Patient choice in the selection of hospitals by 9-1-1 emergency medical services providers in trauma systems

Craig Newgard, N. Clay Mann, Renee Y. Hsia, Eileen M. Bulger, Oscar Ma, Kristan Staudenmayer, Jason S. Haukoos, Ritu Sahni, Nathan Kuppermann

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Objectives Reasons for undertriage (transporting seriously injured patients to nontrauma centers) and the apparent lack of benefit of trauma centers among older adults remain unclear; understanding emergency medical services (EMS) provider reasons for selecting certain hospitals in trauma systems may provide insight to these issues. In this study, the authors evaluated reasons cited by EMS providers for selecting specific hospital destinations for injured patients, stratified by age, injury severity, field triage status, and prognosis. Methods This was a retrospective cohort study of injured children and adults transported by 61 EMS agencies to 93 hospitals (trauma and nontrauma centers) in five regions of the western United States from 2006 through 2008. Hospital records were probabilistically linked to EMS records using trauma registries, state discharge data, and emergency department data. The seven standardized reasons cited by EMS providers for selecting hospital destinations included closest facility, ambulance diversion, physician choice, law enforcement choice, patient or family choice, specialty resource center, and other. "Serious injury" was defined as an Injury Severity Score (ISS) ≥ 16, and unadjusted in-hospital mortality was considered as a marker of prognosis. All analyses were stratified by age in 10-year increments, and descriptive statistics were used to characterize the findings. Results A total of 176,981 injured patients were evaluated and transported by EMS over the 3-year period, of whom 5,752 (3.3%) had ISS ≥ 16 and 2,773 (1.6%) died. Patient or family choice (50.6%), closest facility (20.7%), and specialty resource center (15.2%) were the most common reasons indicated by EMS providers for selecting destination hospitals; these frequencies varied substantially by patient age. The frequency of patient or family choice increased with increasing age, from 36.4% among 21- to 30-year-olds to 75.8% among those older than 90 years. This trend paralleled undertriage rates and persisted when restricted to patients with serious injuries. Older patients with the worst prognoses were preferentially transported to major trauma centers, a finding that was not explained by field triage protocols. Conclusions Emergency medical services transport patterns among injured patients are not random, even after accounting for field triage protocols. The selection of hospitals appears to be heavily influenced by patient or family choice, which increases with patient age and involves inherent differences in patient prognosis.

Original languageEnglish (US)
Pages (from-to)911-919
Number of pages9
JournalAcademic Emergency Medicine
Volume20
Issue number9
DOIs
StatePublished - Sep 2013

Fingerprint

Emergency Medical Services
Wounds and Injuries
Triage
Trauma Centers
Injury Severity Score
Ambulance Diversion
Law Enforcement
Hospital Records
Hospital Mortality
Medical Records
Registries
Hospital Emergency Service
Cohort Studies
Retrospective Studies

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Patient choice in the selection of hospitals by 9-1-1 emergency medical services providers in trauma systems. / Newgard, Craig; Mann, N. Clay; Hsia, Renee Y.; Bulger, Eileen M.; Ma, Oscar; Staudenmayer, Kristan; Haukoos, Jason S.; Sahni, Ritu; Kuppermann, Nathan.

In: Academic Emergency Medicine, Vol. 20, No. 9, 09.2013, p. 911-919.

Research output: Contribution to journalArticle

Newgard, C, Mann, NC, Hsia, RY, Bulger, EM, Ma, O, Staudenmayer, K, Haukoos, JS, Sahni, R & Kuppermann, N 2013, 'Patient choice in the selection of hospitals by 9-1-1 emergency medical services providers in trauma systems', Academic Emergency Medicine, vol. 20, no. 9, pp. 911-919. https://doi.org/10.1111/acem.12213
Newgard, Craig ; Mann, N. Clay ; Hsia, Renee Y. ; Bulger, Eileen M. ; Ma, Oscar ; Staudenmayer, Kristan ; Haukoos, Jason S. ; Sahni, Ritu ; Kuppermann, Nathan. / Patient choice in the selection of hospitals by 9-1-1 emergency medical services providers in trauma systems. In: Academic Emergency Medicine. 2013 ; Vol. 20, No. 9. pp. 911-919.
@article{73dcec2aea854aae8ebf7a667bda85e0,
title = "Patient choice in the selection of hospitals by 9-1-1 emergency medical services providers in trauma systems",
abstract = "Objectives Reasons for undertriage (transporting seriously injured patients to nontrauma centers) and the apparent lack of benefit of trauma centers among older adults remain unclear; understanding emergency medical services (EMS) provider reasons for selecting certain hospitals in trauma systems may provide insight to these issues. In this study, the authors evaluated reasons cited by EMS providers for selecting specific hospital destinations for injured patients, stratified by age, injury severity, field triage status, and prognosis. Methods This was a retrospective cohort study of injured children and adults transported by 61 EMS agencies to 93 hospitals (trauma and nontrauma centers) in five regions of the western United States from 2006 through 2008. Hospital records were probabilistically linked to EMS records using trauma registries, state discharge data, and emergency department data. The seven standardized reasons cited by EMS providers for selecting hospital destinations included closest facility, ambulance diversion, physician choice, law enforcement choice, patient or family choice, specialty resource center, and other. {"}Serious injury{"} was defined as an Injury Severity Score (ISS) ≥ 16, and unadjusted in-hospital mortality was considered as a marker of prognosis. All analyses were stratified by age in 10-year increments, and descriptive statistics were used to characterize the findings. Results A total of 176,981 injured patients were evaluated and transported by EMS over the 3-year period, of whom 5,752 (3.3{\%}) had ISS ≥ 16 and 2,773 (1.6{\%}) died. Patient or family choice (50.6{\%}), closest facility (20.7{\%}), and specialty resource center (15.2{\%}) were the most common reasons indicated by EMS providers for selecting destination hospitals; these frequencies varied substantially by patient age. The frequency of patient or family choice increased with increasing age, from 36.4{\%} among 21- to 30-year-olds to 75.8{\%} among those older than 90 years. This trend paralleled undertriage rates and persisted when restricted to patients with serious injuries. Older patients with the worst prognoses were preferentially transported to major trauma centers, a finding that was not explained by field triage protocols. Conclusions Emergency medical services transport patterns among injured patients are not random, even after accounting for field triage protocols. The selection of hospitals appears to be heavily influenced by patient or family choice, which increases with patient age and involves inherent differences in patient prognosis.",
author = "Craig Newgard and Mann, {N. Clay} and Hsia, {Renee Y.} and Bulger, {Eileen M.} and Oscar Ma and Kristan Staudenmayer and Haukoos, {Jason S.} and Ritu Sahni and Nathan Kuppermann",
year = "2013",
month = "9",
doi = "10.1111/acem.12213",
language = "English (US)",
volume = "20",
pages = "911--919",
journal = "Academic Emergency Medicine",
issn = "1069-6563",
publisher = "Wiley-Blackwell",
number = "9",

}

TY - JOUR

T1 - Patient choice in the selection of hospitals by 9-1-1 emergency medical services providers in trauma systems

AU - Newgard, Craig

AU - Mann, N. Clay

AU - Hsia, Renee Y.

AU - Bulger, Eileen M.

AU - Ma, Oscar

AU - Staudenmayer, Kristan

AU - Haukoos, Jason S.

AU - Sahni, Ritu

AU - Kuppermann, Nathan

PY - 2013/9

Y1 - 2013/9

N2 - Objectives Reasons for undertriage (transporting seriously injured patients to nontrauma centers) and the apparent lack of benefit of trauma centers among older adults remain unclear; understanding emergency medical services (EMS) provider reasons for selecting certain hospitals in trauma systems may provide insight to these issues. In this study, the authors evaluated reasons cited by EMS providers for selecting specific hospital destinations for injured patients, stratified by age, injury severity, field triage status, and prognosis. Methods This was a retrospective cohort study of injured children and adults transported by 61 EMS agencies to 93 hospitals (trauma and nontrauma centers) in five regions of the western United States from 2006 through 2008. Hospital records were probabilistically linked to EMS records using trauma registries, state discharge data, and emergency department data. The seven standardized reasons cited by EMS providers for selecting hospital destinations included closest facility, ambulance diversion, physician choice, law enforcement choice, patient or family choice, specialty resource center, and other. "Serious injury" was defined as an Injury Severity Score (ISS) ≥ 16, and unadjusted in-hospital mortality was considered as a marker of prognosis. All analyses were stratified by age in 10-year increments, and descriptive statistics were used to characterize the findings. Results A total of 176,981 injured patients were evaluated and transported by EMS over the 3-year period, of whom 5,752 (3.3%) had ISS ≥ 16 and 2,773 (1.6%) died. Patient or family choice (50.6%), closest facility (20.7%), and specialty resource center (15.2%) were the most common reasons indicated by EMS providers for selecting destination hospitals; these frequencies varied substantially by patient age. The frequency of patient or family choice increased with increasing age, from 36.4% among 21- to 30-year-olds to 75.8% among those older than 90 years. This trend paralleled undertriage rates and persisted when restricted to patients with serious injuries. Older patients with the worst prognoses were preferentially transported to major trauma centers, a finding that was not explained by field triage protocols. Conclusions Emergency medical services transport patterns among injured patients are not random, even after accounting for field triage protocols. The selection of hospitals appears to be heavily influenced by patient or family choice, which increases with patient age and involves inherent differences in patient prognosis.

AB - Objectives Reasons for undertriage (transporting seriously injured patients to nontrauma centers) and the apparent lack of benefit of trauma centers among older adults remain unclear; understanding emergency medical services (EMS) provider reasons for selecting certain hospitals in trauma systems may provide insight to these issues. In this study, the authors evaluated reasons cited by EMS providers for selecting specific hospital destinations for injured patients, stratified by age, injury severity, field triage status, and prognosis. Methods This was a retrospective cohort study of injured children and adults transported by 61 EMS agencies to 93 hospitals (trauma and nontrauma centers) in five regions of the western United States from 2006 through 2008. Hospital records were probabilistically linked to EMS records using trauma registries, state discharge data, and emergency department data. The seven standardized reasons cited by EMS providers for selecting hospital destinations included closest facility, ambulance diversion, physician choice, law enforcement choice, patient or family choice, specialty resource center, and other. "Serious injury" was defined as an Injury Severity Score (ISS) ≥ 16, and unadjusted in-hospital mortality was considered as a marker of prognosis. All analyses were stratified by age in 10-year increments, and descriptive statistics were used to characterize the findings. Results A total of 176,981 injured patients were evaluated and transported by EMS over the 3-year period, of whom 5,752 (3.3%) had ISS ≥ 16 and 2,773 (1.6%) died. Patient or family choice (50.6%), closest facility (20.7%), and specialty resource center (15.2%) were the most common reasons indicated by EMS providers for selecting destination hospitals; these frequencies varied substantially by patient age. The frequency of patient or family choice increased with increasing age, from 36.4% among 21- to 30-year-olds to 75.8% among those older than 90 years. This trend paralleled undertriage rates and persisted when restricted to patients with serious injuries. Older patients with the worst prognoses were preferentially transported to major trauma centers, a finding that was not explained by field triage protocols. Conclusions Emergency medical services transport patterns among injured patients are not random, even after accounting for field triage protocols. The selection of hospitals appears to be heavily influenced by patient or family choice, which increases with patient age and involves inherent differences in patient prognosis.

UR - http://www.scopus.com/inward/record.url?scp=84884515869&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84884515869&partnerID=8YFLogxK

U2 - 10.1111/acem.12213

DO - 10.1111/acem.12213

M3 - Article

C2 - 24050797

AN - SCOPUS:84884515869

VL - 20

SP - 911

EP - 919

JO - Academic Emergency Medicine

JF - Academic Emergency Medicine

SN - 1069-6563

IS - 9

ER -