Using Discharge From the Emergency Department or Admission of Less Than 24 Hours as a Metric for Inappropriate Helicopter Emergency Medical Services Utilization in Adult Trauma Patients Transported to the Emergency Department.

内容摘要

The Commission on Accreditation of Medical Transport Systems has used patients being admitted for less than 24 hours at the receiving facility as a surrogate marker for improper helicopter emergency medical services (HEMS) utilization, therefore triggering a review to determine proper HEMS utilization. Recent guidelines modified this to use discharge directly from the emergency department (ED) after transfer as a marker for inappropriate HEMS utilization. This study aimed to evaluate which metric is associated with better adherence to Wisconsin (WI) HEMS utilization criteria in adult trauma patients transported to the ED. This was a retrospective chart review of 1,520 transports by a midwestern HEMS service to a level 1 adult trauma center between January 1, 2013, and December 31, 2022. Charts with a disposition of discharge home, admission of less than 24 hours, or death in the ED were evaluated for adherence to WI HEMS utilization guideline criteria. A total of 287 patients met the inclusion criteria. Most patients were transported directly from the scene; 53% of transports met utilization criteria. Interfacility transports were more likely to meet utilization criteria than scene transports. Patients admitted for less than 24 hours were more likely to meet utilization criteria than patients discharged directly from the ED. This significance occurred for both scene and interfacility transports. Patients transported after a motor vehicle crash were less likely to have met utilization criteria. Patients admitted for less than 24 hours were more likely to have met WI HEMS utilization guidelines than patients discharged from the ED. The relatively low adherence rate to the WI HEMS utilization guidelines suggests that stricter guidelines may be necessary to reduce overtriaging in HEMS transport.