Reaching the right facility for emergency patients - destinations of patients transported by emergency medical...

Ensuring that emergency patients reach the right healthcare facility at the right time is a key component of providing quality emergency care. Rwanda's prehospital emergency care system, Service D'Aide Médicale Urgente (SAMU), was established in 2007 to provide prehospital emergency care services, but a formal assessment of the receiving facilities has not been done. We explored the characteristics of patients transported by SAMU to identify factors influencing the choice of destination health facilities.

We retrospectively analyzed SAMU data documenting patients transported in Kigali in 2022. The main dataset included patient sex, age, emergency condition, insurance status, and destination facility. For a subset of patients, additional data were available on clinical variables such as Glasgow Coma Score (GCS), variables to permit derivation of the Triage Early Warning Scores (TEWS), and an assessment of urgency made by the ambulance team. Facilities receiving patients transported by SAMU were categorised into health centers, district hospitals, and tertiary hospitals. Results are described for the main dataset, and associations between facility type and patient characteristics were determined using multinomial logistic regression on the subset of patients with additional clinical variables.

Data was available for 7,221 patients. The majority were male (65%), with a mean age of 34 years (SD = 16). The leading three emergency conditions were trauma (66%), gynecological and obstetric conditions (9%), and medical conditions (17%). Most patients were received by district hospitals (47%), followed by health centers (36%), and tertiary hospitals (17%). We also found that patients with urgency classified as "extreme" had a 49%, 37%, and 14% probability of being transferred to tertiary hospitals, district hospitals, and health centers respectively. Similarly, patients with TEWS of 7 or higher had a 53%, 29%, and 18% chance of being transported to tertiary hospitals, district hospitals, and health centers respectively. Age, sex, and insurance status were not associated with facility type. In the multinomial analysis, patients with trauma had a 44%, 38%, and 18% probability of being transferred to district hospitals, health centers, and tertiary hospitals respectively. Women with obstetrics and gynecology conditions had a 56%, 35%, and 8% probability of being transported to district hospitals, health centers, and tertiary hospitals respectively.

We identified that patients' age and urgency of the condition were associated with destination; however, insurance and TEWS scores were found to have less influence.