Regionalization of Care: Position Statement of the National Association of State EMS Officials

Approved by the NASEMSO Executive Committee on December 10, 2009. Received February 12, 2010; accepted for publication February 19, 2010.

Address correspondence and reprint requests to: National Association of State EMS Officials, 201 Park Washington Court, Falls Church, VA 22046-4527. e-mail: [email protected]

Position Statement

In the 2006 report The Future of Emergency Care in the United States,¹ the Institute of Medicine recommends regionalization of emergency systems of care, particularly for time-critical and specialty-resource limited conditions. Current examples of these conditions include trauma, stroke, ST-segment elevation myocardial infarction (STEMI)/cardiac arrest, burns, poisonings, and pediatric emergencies.

Regionalization is the categorization, integration, and coordination of prehospital and hospital resources. It is not the centralization of care. Rather, regionalization is inclusive and incorporates care provided at all levels into a single system of care: dispatch to emergency medical services (EMS) to small or rural facility to major tertiary care center. Each component of the regionalized system plays a role within its capabilities.

Regionalization allows each time-critical or specialty-limited system of care to be specifically tailored to best address local and regional medical capabilities, as well as geographic, political, and commercial considerations. For a given geographic area, each system of care should be individually designed to integrate the resources available at each level to best serve the interests of the patient. However, each system of care places different requirements on each link of the regionalized chain. Therefore, within the same geographic area, the STEMI system of care may be organized differently than the trauma system of care because of different resources available for each condition.

State-level facilitation, oversight, and coordination of regionalization are recommended as an adjunct to local or regional supervision of each system of care.² The state EMS office is well positioned to assist in and oversee the development of these regionalized systems of care, securely collect and analyze systemwide data, and provide process-improvement feedback to the involved agencies. The state EMS office can act as a “neutral arbiter” that can view the overall system from the perspective of optimal patient care.

Designation or categorization of facilities and agencies within each system of care may facilitate system development. Standardization of such designation criteria would simplify interstate coordination of patient care.

Benefits of regionalization of care include the following:

• Enhanced patient access to timely, efficient, coordinated, and, where possible, evidence-based care

• Enhanced communication and information flow between EMS and hospital resources

• Better utilization of local and regional resources

• Minimization of competitive duplication of resources

• Optimization of the use of limited physician specialty expertise

• Encouragement of effective early medical intervention in time-critical conditions, leading to decreased patient death and disability, shortened hospital stays, and cost savings on acute, rehabilitative, and long-term care

• Facilitation of data exchange and ongoing performance improvement for the entire system of care, permitting

  • integration of patient outcome and resource utilization studies

  • evaluation of the system with clearly defined process and structure performance measures

  • ongoing modification of system protocols and procedures based on process-improvement evaluation and current best evidence