ArticleHealth services research2022
Potential bypassing of nearest emergency department by EMS transports.
Article in Health services research, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
10 citing papers in PubMed, 12 citations in OpenAlex.
- Disparities in direct access to acute geriatric care - an observational analysis of geographic variations of ambulance conveyance.BMC geriatrics · 2026Observational
- Variation in Emergency Department Experience With Pediatric Critical Illness.Annals of emergency medicine · 2026Article
- Rural-Urban Differences in Emergency Department Choice for Children With Medical Complexity, 2012-2017.Pediatric emergency care · 2025Article
- Out-of-State Acute Care Use Among Pediatric Medicaid Enrollees.JAMA network open · 2025Article
- Hospital ownership and admission rates from the emergency department, evidence from Florida.Health services research · 2024Article
- Structural Factors and Racial/Ethnic Inequities in Travel Times to Acute Care Hospitals in the Rural US South, 2007-2018.The Milbank quarterly · 2023Article
- Ambulance use and subsequent fragmented hospital readmission among older adults.Journal of the American Geriatrics Society · 2023Article
- A Conceptual Framework for Optimizing the Equity of Hospital-Based Emergency Care: The Structure of Hospital Transfer Networks.The Milbank quarterly · 2023Article
- Association of distance between hospitals and volume of shared admissions.BMC health services research · 2022Article
- Potential bypassing of nearest emergency department by EMS transports.Health services research · 2022Article
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 2 countries.
Funding
Abstract
objectiveGuidelines recommend emergency medical services (EMS) patients to be transported to the nearest appropriate emergency department (ED). Our objective was to estimate the prevalence of EMS transport to an ED other than the nearest ED ("potential bypassing"). DATA SOURCES: Illinois Prehospital Patient Care Report Data of EMS transports (July 2019 to December 2019). DATA COLLECTION/EXTRACTION
methodsWe identified all EMS ground transports with an advanced life-support (ALS) paramedic to an ED for patients aged 21 years and older. Using street address of incident location, we performed geocoding and driving route analyses and obtained estimated driving distance and time to the destination ED and alternative EDs. MAIN OUTCOME AND MEASURES: Our main outcomes were dichotomous indicators of potential bypassing of the nearest ED based on distance and time. As secondary outcomes we examined potential bypassing indicators based on excess driving distance and time. STUDY
designWe used Poisson regression models to obtain adjusted relative rates of potential bypassing indicators by acuity level, primary impression, patient demographics and geographic characteristics. PRINCIPAL
findingsOur study cohort of 361,051 EMS transports consisted of 5.8% critical, 37.2% emergent and 57.0% low acuity cases transported to 222 EDs. The observed rate of potential bypassing was approximately 34% of cases for each acuity level. Treating the cardiovascular primary impression code group as the reference case, we found small to no differences in potential bypassing rates across other primary impression code groups of all acuity levels, with the exception of critical acuity trauma cases for which potential bypassing rate was 64% higher (incidence rate ratio = 1.64, 95% confidence interval, 1.54-1.74). Compared to zip codes with one ED within a 5-mile vicinity, potential bypassing was higher in areas with no ED or multiple EDs within a 5-mile vicinity.
conclusionApproximately one-third of EMS transports potentially bypassed the nearest ED. EMS transport destination may be motivated by factors other than proximity.
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Registered trials
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