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Lane BH, Rea DJ, Gottula AL, Cathers AD, Ziegler RM, Latimer AJ, Danielson KR, Theiling BJ, Froehle CM, Hinckley WR. Association of Geographic Distance and Hospital Characteristics With Use of Interhospital Transfer by Air: A Multicenter Retrospective Study. Air Med J 2024; 43:111-115. [PMID: 38490773 DOI: 10.1016/j.amj.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/21/2023] [Accepted: 11/01/2023] [Indexed: 03/17/2024]
Abstract
OBJECTIVE Interhospital transfer by air (IHTA) represents the majority of helicopter air ambulance transports in the United States, but the evaluation of what factors are associated with utilization has been limited. We aimed to assess the association of geographic distance and hospital characteristics (including patient volume) with the use of IHTA. METHODS This was a multicenter, retrospective study of helicopter flight request data from 2018 provided by a convenience sample of 4 critical care transport medicine programs in 3 US census regions. Nonfederal referring hospitals located in the home state of the associated critical care transport medicine program and within 100 miles of the primary receiving facility in the region were included if complete data were available. We fit a Poisson principal component regression model incorporating geographic distance, the number of emergency department visits, the number of hospital discharges, case mix index, the number of intensive care unit beds, and the number of general beds and tested the association of the variables with helicopter emergency medical services utilization. RESULTS A total of 106 referring hospitals were analyzed, 21 of which were hospitals identified as having a consistent request pattern. Using the hospitals with a consistent referral pattern, geographic distance had a significant positive association with flight request volume. Other variables, including emergency department visit volume, were not associated. Overall, the included variables offered poor explanatory power for the observed variation between referring facilities in the use of IHTA (r2 = 0.09). Predicted flights based on the principal component regression model for all referring hospitals suggested the majority of referring hospitals used multiple flight programs. CONCLUSION Geographic distance is associated with the use of IHTA. Unexpectedly, most basic hospital characteristics are not associated with the use of IHTA, and the degree of variation between referring facilities that is explained by patient volume is limited. The evaluation of nonhospital factors, such as the density and availability of critical care or advanced life support ground emergency medical services resources, is needed.
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Affiliation(s)
- Bennett H Lane
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH; UC Health Air Care & Mobile Care, Cincinnati, Ohio.
| | - David J Rea
- Department of Decision and Technology Analytics, Lehigh University, Bethlehem, PA; Lehigh University College of Health, Bethlehem, PA
| | - Adam L Gottula
- Departments of Anesthesia and Emergency Medicine, University of Michigan, Ann Arbor, MI
| | - Andrew D Cathers
- Department of Emergency Medicine, University of Wisconsin, Madison, WI; UW Health Med Flight, Department of Emergency Medicine, University of Wisconsin, Madison, WI
| | - Ryan M Ziegler
- UW Health Med Flight, Department of Emergency Medicine, University of Wisconsin, Madison, WI
| | - Andrew J Latimer
- Department of Emergency Medicine, University of Washington, Seattle, WA; Airlift Northwest, Seattle, WA
| | | | - B Jason Theiling
- Division of Emergency Medicine, Department of Surgery, Duke University, Durham, NC; Emergency Services Clinical Service Unit, Duke University Hospital, Durham, NC; Duke Life Flight, Durham, NC
| | - Craig M Froehle
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH; Department of Operations, Business Analytics and Information Systems, University of Cincinnati, Cincinnati, OH
| | - William R Hinckley
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH; UC Health Air Care & Mobile Care, Cincinnati, Ohio
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Ulvin OE, Skjærseth EÅ, Haugland H, Thorsen K, Nordseth T, Orre MF, Vesterhus L, Krüger AJ. The introduction of a regional Norwegian HEMS coordinator: an assessment of the effects on response times, geographical service areas and severity scores. BMC Health Serv Res 2022; 22:1020. [PMID: 35948977 PMCID: PMC9365225 DOI: 10.1186/s12913-022-08337-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 07/12/2022] [Indexed: 11/24/2022] Open
Abstract
Background Due to unwanted delays and suboptimal resource control of helicopter emergency medical services (HEMS), regional HEMS coordinators have recently been introduced in Norway. This may represent an unnecessary link in the alarm chain, which could cause delays in HEMS dispatch. Systematic evaluations of this intervention are lacking. We wanted to conduct this study to assess possible changes in HEMS response times, mission distribution patterns and patient characteristics within our region following this intervention. Methods We retrospectively collected timeline parameters, patient characteristics and GPS positions from HEMS missions executed by three regional HEMS bases in Mid-Norway during 2017–2018 (preintervention) and 2019 (postintervention). The mean regional response time in HEMS missions was assessed by an interrupted time series analysis (ITS). The geographical mission distribution between regional HEMS resources was assessed by a before-after study with a convex hull-based method. Results There was no significant change in the level (-0.13 min/month, p = 0.88) or slope (-0.13 min/month, p = 0.30) of the mean regional response time trend line pre- and postintervention. For one HEMS base, the service area was increased, and the median mission distance was significantly longer. For the two other bases, the service areas were reduced. Both the mean NACA score (4.13 ± SD 0.027 vs 3.98 ± SD 0.04, p < 0.01) and the proportion of patients with severe illness or injury (NACA 4–7, 68.2% vs 61.5%, p < 0.001) were higher in the postintervention group. Conclusion The introduction of a regional HEMS coordinator in Mid-Norway did not cause prolonged response times in acute HEMS missions during the first year after implementation. Higher NACA scores in the patients treated postintervention suggest better selection of HEMS use.
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Affiliation(s)
- Ole Erik Ulvin
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway. .,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. .,Department of Emergency Medicine and Pre-Hospital Services, St. Olav`s University Hospital, Trondheim, Norway. .,Department of Anaesthesia and Intensive Care Medicine, St. Olav`s University Hospital, Trondheim, Norway.
| | - Eivinn Årdal Skjærseth
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav`s University Hospital, Trondheim, Norway
| | - Helge Haugland
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav`s University Hospital, Trondheim, Norway.,Department of Anaesthesia and Intensive Care Medicine, St. Olav`s University Hospital, Trondheim, Norway
| | - Kjetil Thorsen
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Trond Nordseth
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Anaesthesia and Intensive Care Medicine, St. Olav`s University Hospital, Trondheim, Norway.,Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Marie Falch Orre
- Department of Civil and Environmental Engineering, Master's Degree Programme of Engineering and ICT, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Lars Vesterhus
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav`s University Hospital, Trondheim, Norway
| | - Andreas Jørstad Krüger
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Emergency Medicine and Pre-Hospital Services, St. Olav`s University Hospital, Trondheim, Norway
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