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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.
- accident & emergency medicine
- psychiatry
- epidemiology
- health services administration & management
- mental health
Data availability statement
Data may be obtained from a third party and are not publicly available. The data that support the findings of this study are available Ministry of Internal Affairs and Communications. Restrictions apply to the availability of these data, which were used under license for this study. Data are available from the authors with the permission of Ministry of Internal Affairs and Communications.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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- accident & emergency medicine
- psychiatry
- epidemiology
- health services administration & management
- mental health
Data availability statement
Data may be obtained from a third party and are not publicly available. The data that support the findings of this study are available Ministry of Internal Affairs and Communications. Restrictions apply to the availability of these data, which were used under license for this study. Data are available from the authors with the permission of Ministry of Internal Affairs and Communications.
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Footnotes
Twitter @hidetamune
Contributors TC, TS, RT and HT were responsible for developing the initial research question and design. TC and TS were project administrators. TC prepared the original draft. RT and EI performed data curation and formal analysis. HT, MR, SI and TS reviewed and critically revised the manuscript for important intellectual content and approved the final version for publication. SI and TS supervised the project. TC is responsible for the overall content as guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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