Evidence map›Paper›PMID 37208561›Full record

ArticleCJEM2023

The association between paramedic service system hospital offload time and response time.

I E Blanchard, T S Williamson, B E Hagel, D J Niven, D J Lane, S Dean, M N Shah, E S Lang, C J Doig

Abstract read
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In one paragraph

Article in CJEM, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors.

I E BlanchardAlberta Health Services (Emergency Medical Services, Emergency, Critical Care), Edmonton, AB, Canada. ian.blanchard@ahs.ca.ORCID http://orcid.org/0000-0002-3619-3196
T S WilliamsonUniversity of Calgary (Cumming School of Medicine-Community Health Sciences, Critical Care, Emergency, and Pediatrics, Faculty of Kinesiology-Sports Injury Prevention Research Centre, Alberta Children's Hospital Research Institute; and O'Brien Institute for Public Health), Calgary, AB, Canada.
B E HagelUniversity of Calgary (Cumming School of Medicine-Community Health Sciences, Critical Care, Emergency, and Pediatrics, Faculty of Kinesiology-Sports Injury Prevention Research Centre, Alberta Children's Hospital Research Institute; and O'Brien Institute for Public Health), Calgary, AB, Canada.
D J NivenAlberta Health Services (Emergency Medical Services, Emergency, Critical Care), Edmonton, AB, Canada.
D J LaneFaculty of Medicine, Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.
S DeanAlberta Health Services (Emergency Medical Services, Emergency, Critical Care), Edmonton, AB, Canada.
M N ShahSchool of Medicine and Public Health, BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA.
E S LangAlberta Health Services (Emergency Medical Services, Emergency, Critical Care), Edmonton, AB, Canada.
C J DoigAlberta Health Services (Emergency Medical Services, Emergency, Critical Care), Edmonton, AB, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo address an important care issue in Canada, we tested the association between paramedic system hospital offload and response time, while considering the impact of other system-level factors.

methodsData from Calgary, Alberta (2014-2017), included median offload (exposure) and response (outcome) time aggregated by hour, with covariates paramedic system episodes of care-dispatch and arrival of a response unit-and hospital transport arrivals (collectively called volume), time of day, and season. Analyses used linear regression and modified Poisson models.

results301,105 EMS episodes of care over 26,193 1-h periods were included. For any given 1-h period, the median (IQR) across all episodes of care for offload time, response time, episodes of care, and hospital transport arrivals were 55.3 (45.7, 66.3) min, 8.6 (7.6, 9.8) min, 12 (8, 16) episodes, and 8 (5, 10) hospital arrivals, respectively. Multivariable modelling revealed a complex association differing over levels of exposure and covariates, requiring description using "light stress" and "heavy stress" system scenarios. The light scenario was defined as median offload of 30 min and volume < 10th percentile (six episodes and four hospital arrivals), in the summer, and the heavy scenario as median offload of 90 min and volume > 90th percentile (17 episodes and 13 hospital arrivals), in the winter. An increase is reported in minutes:seconds for median hourly response time between scenarios by time of day: 1:04-4:16 (0000-0559 h.), 0:42-2:05 (0600-1159 h.), 0:57-3:01 (1200-1759 h.), and 0:18-2:21 (1800-2359 h.).

conclusionsIncreasing offload is associated with increased response time; however the relationship is complex, with a greater impact on response time noted in select situations such as high volume in the winter. These observations illustrate the interdependence of paramedic, ED, and inpatient systems and provide high-yield targets for polices to mitigate the risk to community availability of paramedic resources at times of high offload delay/system stress.

Indexed as

Emergency Medical ServicesAlbertaAmbulancesEmergency Service, HospitalHospitalsHumansParamedicsReaction TimeTransportation of PatientsEmergency Medical ServicesHospital timeOffload timeParamedicResponse time

Identifiers

PMID37208561

What OpenQuestion holds

Textmetadata
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.