The 130th Annual Meeting of APHA

Abstract #49085

Lynne Fullerton-Gleason, PhD¹, Cameron Crandall, MD², Phil Froman, MD³, Micha Campbell, EMT³, Michael Jambrosic, BA³, and David P. Sklar, MD¹. (1) Department of Emergency Medicine, University of New Mexico School of Medicine, ACC 4-West, Albuquerque, NM 87131-5246, 505-272-5062, lfullerton@salud.unm.edu, (2) Center for Injury Prevention, Research, and Education, University of New Mexico, Department of Emergency Medicine, ACC 4-West, Albuquerque, NM 87131-5246, (3) Albuquerque Ambulance Services, 4th Street NW, Albuquerque, NM 87109

INTRODUCTION. Overcrowded emergency departments (EDs) result in ambulance diversions, hospitals being temporarily forced open, extended ambulance drop times, and delays to definitive care.

METHODS. We reviewed ambulance drop times (the time needed to transfer patient care to ED staff) over a two-year period for all hospitals in Albuquerque, NM, and the number of hours hospitals were forced open during an overlapping 3-year period. EDs that were closed due to overcrowding or lack of patient beds were forced open when a predefined threshold of closed EDs is reached.

RESULTS. EDs were forced open an average of 50 hours per month, and increased 3.5 hours per month (95% CI=2.1, 4.9) over three years. From July 1999 to August 2001, average patient drop time increased 1.5 minutes per patient (linear regression R-squared=.23), resulting in an average of 350 extra unit hours per month. The approximate cost per ambulance unit hour is $80; this translates to a cost of over one million dollars during the 3 years of the study. Hours forced open and extra unit hours were highly correlated (r=.68; 95% CI=.40, .85). Trends in hours forced open, ambulance unit hours, and patient drop times were all significant (p<.0001).

CONCLUSION. Consequences of delays of transfer of care of acutely ill patients to definitive care include loss of EMS services for other patients and increased costs. Forced opening of overcrowded EDs may attenuate these problems but may place patients in facilities unable to provide timely care and supervision.

Learning Objectives:

• Understand recent trends in ambulance drop times and hours emergency departments are forced open;
• Describe the relationship between ambulance drop times and hours emergency departments are forced open;
• Identify one financial cost of emergency department forced openings;
• Discuss possible consequences to patients and health care workers of forcing overcrowded emergency departments to accept patients.

Keywords: Emergency Department/Room, Emerging Health Issues

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.