Matching Capacity to Demand: A Regional Dashboard Reduces Ambulance Avoidance and Improves Accessibility of Receiving Hospitals

Authors

  • Bruce McLeod MD,

    1. From the Division of Emergency Medicine (BM, FZ, ESL), University of Calgary (CA), and the Department of Emergency Medicine (DW, KJ, ESL), Alberta Health Services (DPM), Calgary, Alberta, Canada.
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  • Fareen Zaver,

    1. From the Division of Emergency Medicine (BM, FZ, ESL), University of Calgary (CA), and the Department of Emergency Medicine (DW, KJ, ESL), Alberta Health Services (DPM), Calgary, Alberta, Canada.
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  • Chris Avery,

    1. From the Division of Emergency Medicine (BM, FZ, ESL), University of Calgary (CA), and the Department of Emergency Medicine (DW, KJ, ESL), Alberta Health Services (DPM), Calgary, Alberta, Canada.
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  • Duane P. Martin MSc,

    1. From the Division of Emergency Medicine (BM, FZ, ESL), University of Calgary (CA), and the Department of Emergency Medicine (DW, KJ, ESL), Alberta Health Services (DPM), Calgary, Alberta, Canada.
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  • Dongmei Wang PhD,

    1. From the Division of Emergency Medicine (BM, FZ, ESL), University of Calgary (CA), and the Department of Emergency Medicine (DW, KJ, ESL), Alberta Health Services (DPM), Calgary, Alberta, Canada.
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  • Kim Jessen RN,

    1. From the Division of Emergency Medicine (BM, FZ, ESL), University of Calgary (CA), and the Department of Emergency Medicine (DW, KJ, ESL), Alberta Health Services (DPM), Calgary, Alberta, Canada.
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  • Eddy S. Lang MD

    1. From the Division of Emergency Medicine (BM, FZ, ESL), University of Calgary (CA), and the Department of Emergency Medicine (DW, KJ, ESL), Alberta Health Services (DPM), Calgary, Alberta, Canada.
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  • The authors have no disclosures or conflicts of interest to report.

  • Supervising Editor: Mark Hauswald, MD, PhD.

Address for correspondence and reprints: Eddy S. Lang, MD; e-mail: eddy.lang@albertahealthservices.ca.

Abstract

Objectives:  Ambulance diversion is a dangerous repercussion of emergency department (ED) crowding and can reflect fragmentation and a lack of coordination in designating optimal patient offload sites for prehospital providers. The objective of this study was to evaluate whether proactive destination selection through the Regional Emergency Patient Access and Coordination (REPAC) program would enhance capacity and ED flow management.

Methods:  The REPAC system provides a dashboard that synthesizes real-time capacity and acuity data for all three adult EDs in the city of Calgary, assigning a color code to reflect receiving status. It assigns destination for the next patient transported by emergency medical services (EMS) by categorizing ED sites as having either a favorable (green/yellow) status or unfavorable (orange/red) status. Three time windows were analyzed: a 6-month window prior to REPAC implementation (pre), the first 6-month window immediately following (post1), and the second 6-month period following (post2). Primary outcomes of interest were the proportion of time spent in favorable versus unfavorable status and EMS avoidances for all adult ED sites in the region (percentage of total time with any center on EMS bypass). Information on total number of ED visits, percentage of patients arriving by EMS transports, admission rates, patient acuity (Canadian Triage and Acuity Score), age, and length of stay (LOS) for admitted and discharged patients was collected. The Kruskal-Wallis test was employed for primary outcome analysis.

Results:  Implementation of the REPAC system resulted in an increase in the proportion of total time region hospitals reported favorable status (57.5% vs. 64.1%) pre versus post1, an effect that was accentuated at 1 year (post2, 78.7%; p < 0.001 for both comparisons). There was a concomitant decrease in EMS avoidances as a result of the REPAC system, 4.4% to 1.8% (pre vs. post1), also further improved at 1 year to 0.6% (p < 0.001 for both comparisons).

Conclusions:  Proactive EMS destination selection through a real-time integrated electronic surveillance system enhances regional capacity and flow management while significantly reducing ambulance diversions.

ACADEMIC EMERGENCY MEDICINE 2010; 17:1383–1389 © 2010 by the Society for Academic Emergency Medicine

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