High-level Emergency Care Centers and Hospitals with Both Medical/Surgical and Psychiatric Inpatient Beds are associated with a lower rate of difficulty in hospital acceptance and shorter prehospital transfer time for patients seeking care after self-harm behavior

Abstract Ambulance diversion has a significant impact on patient care outcomes. Self-harm behavior in particular is associated with difficulty in hospital acceptance. This is a retrospective observational study using the Japanese ambulance dispatch data in 2015. This study aims to determine if high-level emergency care centers and hospitals with both medical/surgical and psychiatric inpatient beds are associated with a decreased rate of difficulty in hospital acceptance and shorter prehospital transfer times for patients seeking medical care after self-harm behavior using 2015 Japanese ambulance dispatch database. Multivariable analyses were performed for difficulty in hospital acceptance and prehospital transfer time. Covariates such as age, gender, the population density, time, and severity, were included in the analysis, in addition to the presence of high-level emergency care centers and hospitals with both medical/surgical and psychiatric inpatient beds in the city. There was an association between decreased difficulty in hospital acceptance and the presence of high-level emergency care centers (Odds ratio 0.62, 95% Confidence Interval 0.55 to 0.70, P < 0.01) and hospitals with both medical/surgical and psychiatric inpatient beds (OR = 0.49, 95%CI, 0.37 to 0.65, P < 0.01). There was significant reduction in prehospital transfer time in the city with high-level emergency care centers (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). High-level emergency care centers and hospitals with both medical/surgical and psychiatric inpatient beds were associated with significant decrease in difficulty in hospital acceptance and shorter prehospital transfer time. (The graphical abstract is shown in Fig. 1.)