Are Hospitals with Both Medical/surgical and Psychiatric Services Associated with Decreased Difficulty in Ambulance Transfer for Patients with Self-harm Behaviour? A Nationwide Retrospective Observational Study Using Ambulance Transfer Data in Japan

Overview

Journal BMJ Open

Specialty General Medicine

Date 2023 Feb 24

PMID 36828651

Authors

Takuyo Chiba

Reo Takaku

Erina Ito

Hidetaka Tamune

Marisa Rivera

Shunya Ikeda

Takashi Shiga

Affiliations

Soon will be listed here.

Abstract

Objectives: Ambulance diversion and prolonged prehospital transfer time have a significant impact on patient care outcomes. Self-harm behaviour in particular is associated with difficulty in hospital acceptance and longer prehospital transfer time. This study aimed to determine if hospitals with both medical/surgical and psychiatric inpatient beds and high-level emergency care centres are associated with a decreased rate of difficulty in hospital acceptance and shorter prehospital transfer time for patients seeking medical care after self-harm behaviour.

Design And Setting: A retrospective observational study using the database of Japanese ambulance dispatch data in 2015.

Participants: Patients who were transferred by ambulances after self-harm behaviour.

Interventions: None.

Main Outcome Measures: Multivariable logistic regression analysis and multivariable linear regression analysis were performed to assess whether the presence of hospitals with both medical/surgical and psychiatric inpatient beds and high-level emergency care centres in the city were associated with a decreased rate of difficulty in hospital acceptance and shorter prehospital transfer time.

Results: The number of transfers due to self-harm behaviour in 2015 was 32 849. There was an association between decreased difficulty in hospital acceptance and the presence of high-level emergency care centres (OR 0.63, 95% CI 0.55 to 0.71, p<0.01) and hospitals with both medical/surgical and psychiatric inpatient beds (OR 0.50, 95% CI 0.38 to 0.66, p<0.01). There was a significant reduction in prehospital transfer time in the city with high-level emergency care centres (4.21 min, 95% CI 3.53 to 4.89, p<0.01) and hospitals with medical/surgical and psychiatric inpatient beds (3.46 min, 95% CI 2.15 to 4.77, p<0.01).

Conclusion: Hospitals with both medical/surgical and psychiatric inpatient beds and high-level emergency care centres were associated with significant decrease in difficulty in hospital acceptance and shorter prehospital transfer time.

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