J Korean Med Sci.  2016 May;31(5):806-813. 10.3346/jkms.2016.31.5.806.

New Intervention Model of Regional Transfer Network System to Alleviate Crowding of Regional Emergency Medical Center

• Ahn JY
• Ryoo HW
• Park J
• Kim JK
• Lee MJ
• Kim JY
• Shin SD
• Cha WC
• Seo JS
• Kim YA

• KMID: 2373682
• DOI: http://doi.org/10.3346/jkms.2016.31.5.806

Abstract

Emergency department (ED) crowding is a serious problem in most tertiary hospitals in Korea. Although several intervention models have been established to alleviate ED crowding, they are limited to a single hospital-based approach. This study was conducted to determine whether the new regional intervention model could alleviate ED crowding in a regional emergency medical center. This study was designed as a "before and after study" and included patients who visited the tertiary hospital ED from November 2011 to October 2013. One tertiary hospital and 32 secondary hospitals were included in the study. A transfer coordinator conducted inter-hospital transfers from a tertiary hospital to a secondary hospital for suitable patients. A total of 1,607 and 2,591 patients transferred from a tertiary hospital before and after the study, respectively (P < 0.001). We found that the median ED length of stay (LOS) decreased significantly from 3.68 hours (interquartile range [IQR], 1.85 to 9.73) to 3.20 hours (IQR, 1.62 to 8.33) in the patient group after implementation of the Regional Transfer Network System (RTNS) (P < 0.001). The results of multivariate analysis showed a negative association between implementation of the RTNS and ED LOS (beta coefficient -0.743; 95% confidence interval -0.914 to -0.572; P < 0.001). In conclusion, the ED LOS in the tertiary hospital decreased after implementation of the RTNS.

Keyword

Crowding; Emergency Medicine; Referral and Consultation; Tertiary Care Centers

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
*Emergency Medical Services
Female
Humans
Length of Stay
Male
Middle Aged
*Models, Theoretical
Multivariate Analysis
Referral and Consultation
Republic of Korea
Tertiary Care Centers
Young Adult

Figure

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  Fig. 1 Transfer process through the Regional Transfer Network System.

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  Fig. 2 Monthly distribution of ED patients and transferred patients through the Regional Transfer Network System. ED, emergency department.

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  Fig. 3 Hourly distribution of patients using the Regional Transfer Network System. The most frequent transfer-request time and actual transfer time were 08:00–09:00 and 09:00–10:00, respectively. Transfer request and actual transfer showed a decreasing trend after 18:00 hours.

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