• Timothy A Burns, Benjamin Kaufman, and Roger M Stone.
• Emergency Medical and Integrated Healthcare Services Section, Montgomery County (MD) Fire and Rescue Service, Gaithersburg, Maryland, USA.
• Prehosp Emerg Care. 2023 Jan 1; 27 (7): 941945941-945.

AbstractObjective: A centralized transport destination officer (TDO) is one technique used by EMS systems to distribute patients. This retrospective analysis examines the effect of a TDO on simultaneous arrivals and consecutive simultaneous arrivals at emergency departments in a suburban EMS system, and their relationship to transport unit throughput.Methods: Each system hospital arrival from July 1, 2020 to February 28, 2022, at six study hospitals was evaluated. An arrival within 300 seconds of the previous arrival at the same hospital was designated as a simultaneous arrival. Any simultaneous arrival where the previous arrival was also a simultaneous arrival was further designated as a consecutive simultaneous arrival. Simultaneous and consecutive simultaneous arrivals were aggregated by day to produce countywide daily totals. Median and interquartile ranges were calculated and a Wilcoxon rank-sum test was used to compare each outcome, with the presence of the TDO as the grouping variable. A Pearson correlation was used to assess the relationship between daily total simultaneous and consecutive simultaneous arrivals to median daily hospital turnaround interval.Results: Median simultaneous arrivals showed a 15% reduction from 21 [IQR: 17 - 26] to 18 [IQR: 15 - 22] (p < 0.001). Consecutive simultaneous arrivals decreased 33%, from 6 [IQR: 4 - 9] to 4 per day [IQR: 2 - 6] on days when the TDO was in place (p < 0.001). Increased total daily simultaneous and consecutive simultaneous arrivals also showed statistically significant correlation with increased median daily hospital turnaround interval (simultaneous r = 0.488, p < 0.001; consecutive simultaneous r = 0.360 p < 0.001).Conclusions: A centralized EMS transport destination officer is associated with a reduction in simultaneous and consecutive simultaneous arrivals of patients in the emergency department. Further analysis also shows a significant correlation between the number of simultaneous and consecutive simultaneous arrivals and transport unit hospital turnaround interval. This technique to achieve load balancing across transport destinations appears to be effective and can be considered in systems experiencing throughput difficulties.

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