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Choi Y, Lee DH, Oh J. Epidemiology and clinical characteristics of trauma in older patients transferred from long-term care hospitals to emergency departments: A nationwide retrospective study in South Korea. Arch Gerontol Geriatr 2023; 115:105212. [PMID: 37774489 DOI: 10.1016/j.archger.2023.105212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/01/2023] [Accepted: 09/23/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND South Korea's aging population had leg to an increased number of long-term care hospitals (LTCHs), and increased transfer of older patients to emergency departments (EDs). This study investigated the epidemiological and injury profiles of LTCH patients aged ≥65 who were transferred from LTCHs to EDs due to trauma. METHOD This retrospective study conducted between January 2014 and December 2019 in South Korea utilized data from the National Emergency Department Information System. The requirement for informed consent was waived by the IRB due to the retrospective nature of the study. Patient information was anonymized prior to analysis. RESULTS Of the 1,472,006 trauma cases aged ≥65, 14,469 came from LTCHs. Outcomes varied: 44.1% were discharged, 40.6% were admitted to general wards (GW), 5.9% to intensive care units (ICU), 2.4% to other hospitals, and 6.5% returned to LTCHs. ED length of stay (LOS) was longest in the death (410.28 ± 559.73 min) and GW admission (390.12 ± 621.71 min) groups. Falls were the main cause of injury (50.1%), and the most common fracture was femoral (71.6%). Femoral and shoulder/upper extremity fractures increased hospitalization risk only, whereas self-harm increased both hospitalization and mortality risk. CONCLUSION Visits to the ED by older patients from LTCH for trauma were avoidable in 50.6% of cases. Additionally, these patients had longer ED LOS and higher hospitalization rates than non-LTCH patients. Falls were the predominant mode of presentation, femoral fracture was the most common fracture among patients from LTCH.
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Affiliation(s)
- Yunhyung Choi
- Department of Emergency Medicine, College of Medicine, Ewha Womans University, Anyangcheonro 1071, YangChoengu, Seoul 07985, Korea; Chung-Ang University Gwangmyeong Hospital, Deokan-ro 110, Gwangmyeong-si, 14353 Gyeonggi-do, Republic of Korea
| | - Duk Hee Lee
- Department of Emergency Medicine, College of Medicine, Ewha Womans University, Anyangcheonro 1071, YangChoengu, Seoul 07985, Korea; Ewha Womans University Mokdong Hospital, Anyangcheonro 1071, Yangchoengu, Seoul 07985, Republic of Korea.
| | - Jongseok Oh
- Postdoctoral researcher, Graduate School of Public Administration, Seoul National University, Room 208, Bld 16, Gwanak-ro 1, Gwanak-gu, Seoul 08826, Republic of Korea.
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Ortahisar BK, Uslu Y. Intra-hospital transfer anxiety of patients in the neurosurgery intensive care unit: A prospective cohort study. Intensive Crit Care Nurs 2023; 78:103464. [PMID: 37354694 DOI: 10.1016/j.iccn.2023.103464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Transferring a patient from the intensive care unit to different locations within the hospital can cause transfer anxiety. Transfer anxiety is an important factor that adversely affects various physiological and psychological parameters. OBJECTIVE The aim of the study is to evaluate the intra-hospital transfer anxiety of patients in a neurosurgery intensive care unit and factors affecting it. METHODS This prospective cohort study was conducted between November 2021 and June 2022 in a neurosurgery intensive care unit in Istanbul. A total of 171 adult patients who stayed in the intensive care unit for at least 24 h, with a Glasgow Coma Scale score of 14 and above and who had undergone their first intra-hospital transfer were included. Patients' vital signs were recorded, and their anxiety levels were assessed using the State-Trait Anxiety Inventory. RESULTS The mean age of the patients was 53.16 ± 15.51 years and 56.72% were women, 75.43% of transfers were performed during the day and 64.32% of patients were transferred to an in-patient ward. Factors affecting transfer anxiety were gender, employment status, timing, and purpose of transfer (p < 0.05). Blood pressures and heart rates tended to increase during transfer and decrease again after transfer, while oxygen saturation decreased during transfer (p = 0.035) and increased again after transfer (p < 0.001). State anxiety levels were moderate before transfer and decreased to mild level after transfer (p < 0.001). CONCLUSIONS The transfer process increased anxiety and caused changes in the vital signs of intensive care patients. Individual and transfer-related factors may influence transfer anxiety. Patients should be monitored for transfer anxiety and nursing interventions to reduce anxiety should be planned. IMPLICATIONS FOR CLINICAL PRACTICE The patients' demographics and transfer details can influence transfer anxiety. Transfer anxiety can affect both subjective parameters and objective measures such as vital signs. Patients at risk of transfer anxiety should be identified before transfers so that nursing interventions to reduce anxiety can therefore be planned.
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Affiliation(s)
| | - Yasemin Uslu
- Nursing Faculty, Istanbul University, Fatih, Istanbul 34452, Turkey.
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Steyn L, Mash RJ, Hendricks G. Use of the Vula App to refer patients in the West Coast District: A descriptive exploratory qualitative study. S Afr Fam Pract (2004) 2022; 64:e1-e9. [PMID: 35532127 PMCID: PMC9082220 DOI: 10.4102/safp.v64i1.5491] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background Referral systems play a pivotal role in coordination and quality of care and should be evaluated for their utility. The Vula App is used by various disciplines and hospitals in South Africa to refer patients. The aim was to explore the perceptions of medical practitioners regarding the use of the Vula App in the West Coast District. Methods A descriptive, exploratory qualitative study used semi-structured interviews with 11 medical practitioners. The highest and lowest users of the Vula App were selected from seven district hospitals. Qualitative data analysis used the framework method and Atlas-ti. Results There were five themes: impact on the referral process, quality of care, coordination of care, continuous professional development, and how to improve the Vula App. Its use was well established in the outpatient and semi-urgent setting, but participants were hesitant to rely on it for immediate advice. Specialist advice via the Vula App enabled practitioners to manage patients remotely. The referral hand-over function had a positive impact on the coordination of care. Advice and feedback via the Vula App assisted with continuous professional development. Conclusion The Vula App is a useful tool to refer patients to the emergency centre and outpatient departments. It can improve the immediate quality of care and sequential coordination of care. It has the potential to enable continuous professional development. There is a need to standardise its use, to ensure electronic information flows back to the district and to integrate the data into the district’s health information system.
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Affiliation(s)
- Louwrens Steyn
- Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.
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Cheng Q, Lai X, Yang L, Yang H, Luo Y. Serum CD5L predicts acute lung parenchymal injury and acute respiratory distress syndrome in trauma patients. Medicine (Baltimore) 2021; 100:e27219. [PMID: 34596119 PMCID: PMC8483880 DOI: 10.1097/md.0000000000027219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/26/2021] [Indexed: 01/05/2023] Open
Abstract
Cluster of differentiation 5 antigen-like (CD5L), derived from alveolar epithelial cells partly, is a secreted protein. It is shown that CD5L is associated with lung inflammation and systemic inflammatory diseases, but the relationship between CD5L and trauma-related acute lung parenchymal injury (PLI), acute lung injury or acute respiratory distress syndrome (ARDS) is unclear. This study aims to explore the value of serum CD5L levels in predicting trauma-associated PLI/ARDS and its potential clinical significance.This is a prospective observational study, and a total of 127 trauma patients were recruited from the emergency department (ED), and among them, 81 suffered from PLI/ARDS within 24 hours after trauma, and 46 suffered from trauma without PLI/ARDS. Fifty healthy subjects from the medical examination center were also recruited as controls for comparison. The serum CD5L level was measured within 24 hours of admission. The receiver operating characteristic analysis and logistic regression analysis were used to identify the correlation between high CD5L and trauma associated-PLI/ARDS within 24 hours following trauma.The trauma associated-PLI/ARDS subjects showed a significantly higher level of serum CD5L on emergency department admission within 24 hours after trauma compared with its level in non-trauma associated-PLI/ARDS subjects and healthy subjects. The initial CD5L concentration higher than 150.3 ng/mL was identified as indicating a high risk of PLI/ARDS within 24 hours following trauma (95% confidence interval: 0.674-0.878; P < .001). Moreover, CD5L was an independent risk factor for trauma associated-PLI/ARDS within 24 hours following trauma.CD5L could predict PLI/ARDS within 24 hours following trauma.
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Affiliation(s)
- Qian Cheng
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Friendship Road, Yuzhong District, Chongqing, China
| | - Xiaofei Lai
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Friendship Road, Yuzhong District, Chongqing, China
| | - Liping Yang
- Department of Laboratory Medicine, Guangyuan Central Hospital, No. 16 Jingxiangzi Road, Lizhou District, Guangyuan City, Sichuan Province, China
| | - Huiqing Yang
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Friendship Road, Yuzhong District, Chongqing, China
| | - Yan Luo
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Friendship Road, Yuzhong District, Chongqing, China
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Back to the 60s: The Heimlich Valve A patient- and family-centered care perspective. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Clevert DA, Sidhu PS, Lim A, Ewertsen C, Mitkov V, Piskunowicz M, Ricci P, Bargallo N, Brady AP. The role of lung ultrasound in COVID-19 disease. Insights Imaging 2021; 12:81. [PMID: 34146161 PMCID: PMC8214066 DOI: 10.1186/s13244-021-01013-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/11/2021] [Indexed: 12/17/2022] Open
Abstract
This statement summarises basic settings in lung ultrasonography and best practice recommendations for lung ultrasonography in COVID-19, representing the agreed consensus of experts from the Ultrasound Subcommittee of the European Society of Radiology (ESR). Standard lung settings and artefacts in lung ultrasonography are explained for education and training, equipment settings, documentation and self-protection.
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Afshari A, Borzou SR, Shamsaei F, Mohammadi E, Tapak L. Perceived occupational stressors among emergency medical service providers: a qualitative study. BMC Emerg Med 2021; 21:35. [PMID: 33757433 PMCID: PMC7988920 DOI: 10.1186/s12873-021-00430-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/12/2021] [Indexed: 01/23/2023] Open
Abstract
Introduction Emergency medical services (EMS) providers are at continuous exposure to occupational stressors which negatively affect their health and professional practice. This study explored perceived occupational stressors among EMS providers. Methods This qualitative study was conducted from December 2019 to April 2020 using conventional content analysis. Sixteen EMS providers were purposively selected from EMS stations in Hamadan, Iran. Semi-structured interviews (with length of 45–60 min) were held for data collection. Data were analyzed through Graneheim and Lundman’s conventional content analysis approach. Findings Data analysis resulted in the development of two themes, namely critical conditions of EMS provision, and personal and professional conflicts. The six categories of these two themes were complexity of patients’ clinical conditions, interruption of EMS provision, health hazards, interpersonal problems, interprofessional interactions, and legal conflicts. Conclusion Besides the stress associated with emergency patient care, EMS providers face many different occupational stressors. EMS managers can use the findings of the present study to develop strategies for reducing occupational stress among EMS providers and thereby, improve their health and care quality.
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Affiliation(s)
- Ali Afshari
- Nursing and Midwifery School, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyed Reza Borzou
- Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Farshid Shamsaei
- Maternal and Child Care Research Center,Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Eesa Mohammadi
- Faculty of Medical Sciences, Nursing Department, Tarbiat Modares University, Tehran, Iran
| | - Leili Tapak
- Department of Biostatistics, School of Public Health, Modeling of Noncommunicable diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
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Öztürk Sönmez L, Katipoğlu B, Vatansev H, Kaykisiz EK, Yüce N, Szarpak L, Evrin T. The Impact of Lung Ultrasound on Coronavirus Disease 2019 Pneumonia Suspected Patients Admitted to Emergency Departments. Ultrasound Q 2021; 37:261-266. [PMID: 34478425 DOI: 10.1097/ruq.0000000000000559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The aim of this study was to identify the sensitivity and specificity of lung ultrasound (LUS) and show its place in diagnosing patients with known coronavirus disease 2019 (COVID-19) pneumonia, according to chest computed tomography and the COVID-19 reporting and data system (CO-RADS). METHODS Nineteen patients who admitted to a single university hospital emergency department between March 5, 2020, and April 27, 2020, describing dyspnea were included in the study and underwent LUS by a single emergency specialist. The patient population was divided into 2 groups, COVID-19 positive and negative, and the sensitivity and specificity of LUS according to chest computed tomography were calculated for COVID-19 pneumonia diagnosis. In the subgroup analysis, the patient group was divided into real-time reverse transcription-polymerase chain reaction positive (n = 7) and negative (n = 12), and sensitivity and specificity were calculated according to the CO-RADS. RESULTS According to the CO-RADS, significant differences were detected between the LUS positive and negative groups in terms of COVID-19 pneumonia presence. Only 1 patient was evaluated as CO-RADS 2 in the LUS positive group, and 2 patients were evaluated as CO-RADS 4 in the LUS negative group (P = 0.04). The sensitivity of LUS according to the CO-RADS for COVID-19 pneumonia diagnosis was measured to be 77.78% (95% confidence interval [CI], 39.9%-97.1%), specificity was 90% (95% CI, 55.5%-99.75%), positive predictive value was 87.5% (95% CI, 51.35%-97.8%), and accuracy was 84.21% (95% CI, 60.4%-96.62%; P = 0.004). CONCLUSIONS In conclusion, LUS is easily used in the diagnosis of COVID-19 pneumonia because it has bedside application and is fast, easy to apply, reproducible, radiation free, safe for pregnant women, and cheap.
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Affiliation(s)
| | - Burak Katipoğlu
- Department of Emergency Medicine, Ufuk University Medical Faculty, Ankara
| | - Hülya Vatansev
- Department of Chest Diseases, Meram Medical Faculty, Necmettin Erbakan University, Konya
| | | | - Nalan Yüce
- Department of Emergency Medicine, Ufuk University Medical Faculty, Ankara
| | | | - Togay Evrin
- Department of Emergency Medicine, Ufuk University Medical Faculty, Ankara
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Geldenhuys L, Wise R, Rodseth R. The impact of a bundled intrahospital transfer protocol on the safety of critically ill patients in a South African Metropolitan Hospital System. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2020. [DOI: 10.36303/sajaa.2020.26.3.2343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- L Geldenhuys
- University of KwaZulu-Natal
- Oxford University Trust Hospitals, UK
- Drs Jones, Bhagwan and Partners
| | - R Wise
- University of KwaZulu-Natal
- Oxford University Trust Hospitals, UK
- Drs Jones, Bhagwan and Partners
| | - R Rodseth
- University of KwaZulu-Natal
- Oxford University Trust Hospitals, UK
- Drs Jones, Bhagwan and Partners
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Odayar J, Myer L. Transfer of primary care patients receiving chronic care: the next step in the continuum of care. Int Health 2020; 11:432-439. [PMID: 31081907 DOI: 10.1093/inthealth/ihz014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/11/2019] [Indexed: 12/26/2022] Open
Abstract
The burden of chronic conditions is increasing rapidly in low- and middle-income countries. Chronic conditions require long-term and continuous care, including for patients transferring between facilities. Patient transfer is particularly important in the context of health service decentralization, which has led to increasing numbers of primary care facilities at which patients can access care, and high levels of migration, which suggest that patients might require care at multiple facilities. This article provides a critical review of existing evidence regarding transfer of stable patients receiving primary care for chronic conditions. Patient transfer has received limited consideration in people living with HIV, with growing concern that patients who transfer are at risk of poor outcomes; this appears similar for people with TB, although studies are few. There are minimal data on transfer of patients with non-communicable diseases, including diabetes. Patient transfer for chronic conditions has thus received surprisingly little attention from researchers; considering the potential risks, more research is urgently required regarding reasons for and outcomes of transfers, transfer processes and interventions to optimize transfers, for different chronic conditions. Ultimately, it is the responsibility of health systems to facilitate successful transfers, and this issue requires increased attention from researchers and policy-makers.
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Affiliation(s)
- Jasantha Odayar
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
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Orešković D, Raguž M, Almahariq F, Dlaka D, Romić D, Marčinković P, Kaštelančić A, Chudy D. The Dubrava Model-A Novel Approach in Treating Acutely Neurotraumatized Patients in Rural Areas: A Proposal for Management. J Neurosci Rural Pract 2019; 10:446-451. [PMID: 31595116 PMCID: PMC6779563 DOI: 10.1055/s-0039-1697777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction
Neurotrauma is one of the leading causes of death and disabilities nowadays and represents one of the largest socioeconomic problems in rich countries, as well as developing ones. A satisfying, medically viable, and cost-effective model of managing acutely neurotraumatized patients, especially ones who come from distant and/or rural areas, has yet to be found. Patient outcome after acute neurotrauma depends on many factors of which the possibility of urgent treatment by an experienced specialist team has a crucial role. Here, we present our own way of managing acutely neurotraumatized patients from distant places which is unique in Croatia, the Dubrava model.
Methods
We present our 5-year experience cooperating with general hospitals in four neighboring cities (Ĉakovec, Bjelovar, Sisak, and Koprivnica) in managing, operating, and taking care of acutely neurotraumatized patients.
Results
More than 300 surgeries have been performed in these hospitals through the Dubrava model. Our experience so far provides encouraging results that this system could also be successfully implemented in other institutions. Furthermore, we recorded an increased number of surgeries each year, as well as a good mutual cooperation with the local general hospitals.
Discussion
This trauma managing model is one of a kind in Croatia. We argue that it is not only better for the patients, providing them with better chances of survival, and disability-free recovery, but is also far superior in many ways to the dominant and currently prevalent way of treating these patients in other parts of Croatia.
Conclusion
The Dubrava model of treating patients in rural and distant areas is a reliable and proven model with many benefits and as such its implementation should be considered in other institutions as well.
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Affiliation(s)
- Darko Orešković
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Marina Raguž
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Fadi Almahariq
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Domagoj Dlaka
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Dominik Romić
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Petar Marčinković
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Anđelo Kaštelančić
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Darko Chudy
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
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Park JH, Lee SC, Shin SD, Song KJ, Hong KJ, Ro YS. Interhospital transfer in low-volume and high-volume emergency departments and survival outcomes after out-of-hospital cardiac arrest: A nationwide observational study and propensity score–matched analysis. Resuscitation 2019; 139:41-48. [DOI: 10.1016/j.resuscitation.2019.03.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 03/07/2019] [Accepted: 03/27/2019] [Indexed: 11/25/2022]
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Preparation and Implementation of Intrahospital Transfer Protocol for Emergency Department Patients to Decrease Unexpected Events. ADVANCED JOURNAL OF EMERGENCY MEDICINE 2018; 2:e29. [PMID: 31172092 PMCID: PMC6549197 DOI: 10.22114/ajem.v0i0.50] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: Most of the patients hospitalized in the emergency department (ED) are in need of transfer to other hospital wards or paraclinic units. This process is called intrahospital transfer (IHT) that may lead to a wide range of complications known as unexpected events (UE). Objective: In the present study we decided to evaluate the effect of using a pre-designed protocol on decrease of UEs and safety improvement of IHT among patients hospitalized in ED. Method: The present cross-sectional study was carried out in 2016 in the ED of Imam Khomeini Hospital, Tehran, Iran. All patients with triage levels of 1 and 2 who were in need of temporary or permanent transfer to other departments of the studied treatment center based on clinical indication as decided by the in-charge physician were enrolled in the study. This study was conducted in 3 phases of pre-intervention, intervention and post-intervention. Any UE was recorded in first phase. During intervention phase ED-IHT protocol was prepared and implemented. the checklist of complications and UEs during transfer was filled again and pre- and post-intervention results were compared. Results: In this study, 207 patients with the mean age of 58.9 ± 20.6 years were evaluated (61.4% male). Demographic data and baseline characteristics of the studied patients in the phases before and after implementation of the protocol has no significant difference. Overall, before implementation of the protocol out of the 105 studied patients, a total of 35 patients (33.3%) were affected by UE during transfer, but after implementation of the protocol this rate decreased to 11 patients (10.8%) out of the 103 studied patients and this decrease was statistically significant (p < 0.001). Conclusion: Based on the results obtained from this study, it seems that performing the IHT protocol specialized for ED patients has been effective in decreasing UE cases.
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Brogi E, Bignami E, Sidoti A, Shawar M, Gargani L, Vetrugno L, Volpicelli G, Forfori F. Could the use of bedside lung ultrasound reduce the number of chest x-rays in the intensive care unit? Cardiovasc Ultrasound 2017; 15:23. [PMID: 28903756 PMCID: PMC5597991 DOI: 10.1186/s12947-017-0113-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 09/05/2017] [Indexed: 12/16/2022] Open
Abstract
Background Lung ultrasound can be used as an alternative to chest radiography (CXR) for the diagnosis and follow-up of various lung diseases in the intensive care unit (ICU). Our aim was to evaluate the influence that introducing a routine daily use of lung ultrasound in critically ill patients may have on the number of CXRs and as a consequence, on medical costs and radiation exposure. Methods Data were collected by conducting a retrospective evaluation of the medical records of adult patients who needed thoracic imaging and were admitted to our academic polyvalent ICU. We compared the number of CXRs and relative costs before and after the introduction of lung ultrasound in our ICU. Results A total of 4134 medical records were collected from January 2010 to December 2014. We divided our population into two groups, before (Group A, 1869 patients) and after (Group B, 2265 patients) the introduction of a routine use of LUS in July 2012. Group A performed a higher number of CXRs compared to Group B (1810 vs 961, P = 0.012), at an average of 0.97 vs 0.42 exams per patient. The estimated reduction of costs between Groups A and B obtained after the introduction of LUS, was 57%. No statistically significant difference between the outcome parameters of the two groups was observed. Conclusions Lung ultrasound was effective in reducing the number of CXRs and relative medical costs and radiation exposure in ICU, without affecting patient outcome.
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Affiliation(s)
- Etrusca Brogi
- Department of Anesthesia and Intensive Care, University of Pisa, Pisa, Italy
| | - Elena Bignami
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - Anna Sidoti
- Department of Anesthesia and Intensive Care, University of Pisa, Pisa, Italy
| | - Mohammed Shawar
- Department of Anesthesia and Intensive Care, University of Pisa, Pisa, Italy
| | - Luna Gargani
- Institute of Clinical Physiology - National Research Council, Pisa, Italy
| | - Luigi Vetrugno
- Department of Medicine, University of Udine, Udine, Italy
| | - Giovanni Volpicelli
- Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Orbassano, Torino, Italy
| | - Francesco Forfori
- Department of Anesthesia and Intensive Care, University of Pisa, Pisa, Italy
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15
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Negrin LL, Prosch H, Kettner S, Halat G, Heinz T, Hajdu S. The clinical benefit of a follow-up thoracic computed tomography scan regarding parenchymal lung injury and acute respiratory distress syndrome in polytraumatized patients. J Crit Care 2016; 37:211-218. [PMID: 27969573 DOI: 10.1016/j.jcrc.2016.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 10/03/2016] [Accepted: 10/05/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate the increase of parenchymal lung injury (PLI) volume between the initial and a follow-up computed tomography (CT) scan and to ascertain which of the 2 scans was more appropriate to predict acute respiratory distress syndrome (ARDS). MATERIAL AND METHODS From 2011 to 2015, polytraumatized patients (≥18 years; ISS ≥ 16) directly admitted to our level I trauma center were included in our prospective study if a follow-up CT scan was possible 24 to 48 hours after the trauma. The PLI volume was measured using volumetric analysis. Statistical calculations were performed to identify patients at risk for ARDS. RESULTS One hundred thirty patients (mean age, 41.3 years; mean ISS, 31.9) met the inclusion criteria. Median relative PLI volume was higher in the follow-up than in the initial CTs (9.65% vs 4.84%; P = .001). The ARDS developed in 42 patients (32.3%). Their initial PLI volume was higher compared with those without ARDS (11.23% vs 2.14%; P < .0001). The ARDS incidence increased with increasing initial PLI volume. Receiver operating characteristic statistics identified initial (area under the curve = 0.753) and follow-up relative PLI volume as a predictor for ARDS (area under the curve = 0.725). CONCLUSIONS The CT scans performed directly after admission are sufficient to define patients at risk for ARDS. Therefore, solely the incidence of PLI does not justify a routine follow-up CT scan.
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Affiliation(s)
- Lukas L Negrin
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria.
| | - Helmut Prosch
- Department of Radiology and Nuclear Medicine, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria.
| | - Stephan Kettner
- Department of Anesthesiology, General Intensive Care and Pain Management, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria.
| | - Gabriel Halat
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria.
| | - Thomas Heinz
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria.
| | - Stefan Hajdu
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria.
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16
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Abstract
The intra- and inter-hospital patient transfer is an important aspect of patient care which is often undertaken to improve upon the existing management of the patient. It may involve transfer of patient within the same facility for any diagnostic procedure or transfer to another facility with more advanced care. The main aim in all such transfers is maintaining the continuity of medical care. As the transfer of sick patient may induce various physiological alterations which may adversely affect the prognosis of the patient, it should be initiated systematically and according to the evidence-based guidelines. The key elements of safe transfer involve decision to transfer and communication, pre-transfer stabilisation and preparation, choosing the appropriate mode of transfer, i.e., land transport or air transport, personnel accompanying the patient, equipment and monitoring required during the transfer, and finally, the documentation and handover of the patient at the receiving facility. These key elements should be followed in each transfer to prevent any adverse events which may severely affect the patient prognosis. The existing international guidelines are evidence based from various professional bodies in developed countries. However, in developing countries like India, with limited infrastructure, these guidelines can be modified accordingly. The most important aspect is implementation of these guidelines in Indian scenario with periodical quality assessments to improve the standard of care.
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Affiliation(s)
- Ashish Kulshrestha
- Department of Anaesthesia and Intensive Care, Vardan Multispecialty Hospital, Garhi Sikrod, NH-58, Meerut Road, Ghaziabad, Uttar Pradesh, India
| | - Jasveer Singh
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
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17
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Baron R, Binder A, Biniek R, Braune S, Buerkle H, Dall P, Demirakca S, Eckardt R, Eggers V, Eichler I, Fietze I, Freys S, Fründ A, Garten L, Gohrbandt B, Harth I, Hartl W, Heppner HJ, Horter J, Huth R, Janssens U, Jungk C, Kaeuper KM, Kessler P, Kleinschmidt S, Kochanek M, Kumpf M, Meiser A, Mueller A, Orth M, Putensen C, Roth B, Schaefer M, Schaefers R, Schellongowski P, Schindler M, Schmitt R, Scholz J, Schroeder S, Schwarzmann G, Spies C, Stingele R, Tonner P, Trieschmann U, Tryba M, Wappler F, Waydhas C, Weiss B, Weisshaar G. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) - short version. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2015; 13:Doc19. [PMID: 26609286 PMCID: PMC4645746 DOI: 10.3205/000223] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Indexed: 02/08/2023]
Abstract
In 2010, under the guidance of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine) and DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine), twelve German medical societies published the “Evidence- and Consensus-based Guidelines on the Management of Analgesia, Sedation and Delirium in Intensive Care”. Since then, several new studies and publications have considerably increased the body of evidence, including the new recommendations from the American College of Critical Care Medicine (ACCM) in conjunction with Society of Critical Care Medicine (SCCM) and American Society of Health-System Pharmacists (ASHP) from 2013. For this update, a major restructuring and extension of the guidelines were needed in order to cover new aspects of treatment, such as sleep and anxiety management. The literature was systematically searched and evaluated using the criteria of the Oxford Center of Evidence Based Medicine. The body of evidence used to formulate these recommendations was reviewed and approved by representatives of 17 national societies. Three grades of recommendation were used as follows: Grade “A” (strong recommendation), Grade “B” (recommendation) and Grade “0” (open recommendation). The result is a comprehensive, interdisciplinary, evidence and consensus-based set of level 3 guidelines. This publication was designed for all ICU professionals, and takes into account all critically ill patient populations. It represents a guide to symptom-oriented prevention, diagnosis, and treatment of delirium, anxiety, stress, and protocol-based analgesia, sedation, and sleep-management in intensive care medicine.
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Affiliation(s)
| | | | | | | | - Stephan Braune
- German Society of Internal Medicine Intensive Care (DGIIN)
| | - Hartmut Buerkle
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI)
| | - Peter Dall
- German Society of Gynecology & Obstetrics (DGGG)
| | - Sueha Demirakca
- German Society of Neonatology and Pediatric Intensive Care (GNPI)
| | | | - Verena Eggers
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI)
| | - Ingolf Eichler
- German Society for Thoracic and Cardiovascular Surgery (DGTHG)
| | | | | | | | - Lars Garten
- German Society of Neonatology and Pediatric Intensive Care (GNPI)
| | | | - Irene Harth
- German Society of Neonatology and Pediatric Intensive Care (GNPI)
| | | | | | - Johannes Horter
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI)
| | - Ralf Huth
- German Society of Neonatology and Pediatric Intensive Care (GNPI)
| | - Uwe Janssens
- German Society of Internal Medicine Intensive Care (DGIIN)
| | | | | | - Paul Kessler
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI)
| | | | | | - Matthias Kumpf
- German Society of Neonatology and Pediatric Intensive Care (GNPI)
| | - Andreas Meiser
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI)
| | - Anika Mueller
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI)
| | | | | | - Bernd Roth
- German Society of Neonatology and Pediatric Intensive Care (GNPI)
| | | | | | | | - Monika Schindler
- German Society of Neonatology and Pediatric Intensive Care (GNPI)
| | - Reinhard Schmitt
- German Society for Specialised Nursing and Allied Health Professions (DGF)
| | - Jens Scholz
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI)
| | - Stefan Schroeder
- German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN)
| | | | - Claudia Spies
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI)
| | | | - Peter Tonner
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI)
| | - Uwe Trieschmann
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI)
| | - Michael Tryba
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI)
| | - Frank Wappler
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI)
| | - Christian Waydhas
- German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI)
| | - Bjoern Weiss
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI)
| | - Guido Weisshaar
- German Society of Neonatology and Pediatric Intensive Care (GNPI)
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18
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Paton L, Stenhouse J, Ruddy J, Howie N. Still Preparing to Fail by Failing to Prepare? A Survey of Trainees' Experience of and Training in Interhospital Transfers. J Intensive Care Soc 2014. [DOI: 10.1177/175114371401500109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Interhospital transfer of critically ill patients is a task frequently delegated to doctors-in-training. However, previous studies have shown them to be ill prepared for this task, prompting the inclusion of transfer medicine as a domain in both anaesthesia and intensive care curricula, though not as yet in emergency medicine. Given the change and variation in curricula, we surveyed anaesthesia and emergency medicine trainees in the West of Scotland to gauge their experience of and training in interhospital transfers. Our results showed trainees continuing to conduct solo interhospital transfers from an early stage in their careers without specific training. Redressing this shortfall in training is imperative, particularly as centralisation of services will require more frequent transport of greater numbers of critically ill patients by trainees. We speculate about why these deficits in transfer training persist and how they might be remedied, particularly given the proposed integration of specialist transport teams in Scotland.
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Affiliation(s)
- Lia Paton
- Specialist Trainee Year 5, Anaesthetics and Intensive Care Medicine, Monklands Hospital, Airdrie
| | - Jude Stenhouse
- Core Trainee Year 2, Emergency Medicine, Monklands Hospital, Airdrie
| | - Jim Ruddy
- Consultant, Anaesthetics and Intensive Care Medicine, Monklands Hospital, Airdrie
| | - Neil Howie
- Consultant, Emergency Medicine, Monklands Hospital, Airdrie
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19
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Sethi D, Subramanian S. When place and time matter: How to conduct safe inter-hospital transfer of patients. Saudi J Anaesth 2014; 8:104-13. [PMID: 24665250 PMCID: PMC3950432 DOI: 10.4103/1658-354x.125964] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Inter-hospital transfer (IHT) of patients is often needed for diagnostic or therapeutic interventions. However, the transfer process carries its own risks as a poorly and hastily conducted transfer could lead to adverse events. In this article, we have reviewed literature on the key elements of IHT process including pre-transfer patient stabilization. We have also discussed various modes of transfer, physiological effects of transfer, possible adverse events and how to avoid or mitigate these. Even critically ill-patients can be transported safely by experienced and trained personnel using appropriate equipment. The patient must be maximally stabilized prior to transfer though complete optimization may be possible only at the receiving hospital. Ground or air transport may be employed depending on the urgency, feasibility and availability. Meticulous pre-transfer check and adherence to standard protocols during the transfer will help keep the entire process smooth and event free. The transport team should be trained to anticipate and manage any possible adverse events, medical or technical, during the transfer. Coordination between the referring and receiving hospitals would facilitate prompt transfer to the definitive destination avoiding delay at the emergency or casualty. Documentation of the transfer process and transfer of medical record and investigation reports are important for maintaining continuity of medical care and for medico-legal purposes.
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Affiliation(s)
- Divya Sethi
- Department of Anesthesiology, Employees’ State Insurance Cooperation, Postgraduate Institute of Medical Sciences and Research, Indraprastha University, New Delhi, India
| | - Shalini Subramanian
- Department of Anesthesiology, Employees’ State Insurance Cooperation, Postgraduate Institute of Medical Sciences and Research, Indraprastha University, New Delhi, India
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20
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Barratt H. Critical Care Transfer Quality 2000–2009: Systematic Review to Inform the ICS Guidelines for Transport of the Critically Ill Adult (3rd ed). J Intensive Care Soc 2012. [DOI: 10.1177/175114371201300409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This paper describes the findings of a systematic literature review that was undertaken to inform the third edition of the Intensive Care Society's (ICS) Guidelines for the Transport of the Critically Ill Adult, which has recently been published. Thirty-eight articles were identified relating to the process of adult patient transfer. The bulk of the articles related to transfer quality, including review articles and audits assessing both the standard of transfers and compliance with relevant guidelines. The review demonstrates that the quality of transfers remains a concern, but much of the data is from single centre audits and case series, which are thought to provide the weakest level of evidence. The guidelines have been extensively updated to reflect both current practice and emerging evidence, but it is clear that measures are still needed to improve the quality of transfers.
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Affiliation(s)
- Helen Barratt
- Research Training Fellow, Department of Applied Health Research, University College London
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21
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A before- and after-intervention trial for reducing unexpected events during the intrahospital transport of emergency patients. Am J Emerg Med 2011; 30:1433-40. [PMID: 22205013 DOI: 10.1016/j.ajem.2011.10.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Revised: 10/25/2011] [Accepted: 10/26/2011] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study was aimed to explore the effect of intervention in safe intrahospital transport on the incidence of unexpected events (UEs) occurring during the transport of emergency patients. METHODS This study was performed in an urban tertiary teaching hospital emergency department (ED) from May 17 to October 30, 2010. Patients older than 15 years who were transported to general wards; intensive care units; and magnetic resonance imaging, intervention, or operation rooms were enrolled. Demographics and data on all UEs related to the devices, clinical situations, and tubes or lines were measured by registered nurses at pre- and postintervention period. The intervention was that acting nurses were required to use a designed transport checklists before the patients were transported. Primary outcomes were the rate of all and serious UEs during the pre- and postintervention periods. Serious UEs were defined as any worsening of a patient's clinical status. Statistical values were measured with 95% confidence intervals (CIs) and compared using Student t tests or χ(2) tests. RESULTS In total, there were 680 transports before interventions and 605 transports after interventions. Overall, UEs decreased significantly from a value of 36.8% (95% CI, 33.1-40.5) in the preintervention period to a value of 22.1% (95% CI, 18.9-25.7) in the postintervention period (P = .001). Serious UEs in clinical status also decreased significantly from 9.1% (95% CI, 7.1-11.5) in the preintervention period to a value of 5.2% (95% CI, 3.6-7.4) in the postintervention period (P = .005). CONCLUSION A significant reduction in the rate of total and serious UEs during intrahospital transport from the ED was found through using transport checklists.
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22
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Ong MS, Coiera E. A systematic review of failures in handoff communication during intrahospital transfers. Jt Comm J Qual Patient Saf 2011; 37:274-84. [PMID: 21706987 DOI: 10.1016/s1553-7250(11)37035-3] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Handoffs serve a critical function in ensuring patient care continuity during transitions of care. Studies to date have predominantly focused on intershift handoffs, with relatively little attention given to intrahospital transfers. A systematic literature review was conducted to characterize the nature of handoff failures during intrahospital transfers and to examine factors affecting handoff communication and the effectiveness of current interventions. METHODS Primary studies investigating handoff communication between care providers during intrahospital transfers were sought in the English-language literature between 1980 and February 2011. Data for study design, population characteristics, sample size, setting, intervention specifics, and relevant outcome measures were extracted. DATA SYNTHESIS Study results were summarized by the impact of communication breakdown during intrahospital transfer of patients, and the current deficiencies in the process. Results of interventions were summarized by their effect on the quality of handoff communication and patient safety. FINDINGS The initial search identified 516 individual articles, 24 of which satisfied the inclusion criteria. Some 19 were primary studies on handoff practices and deficiencies, and the remaining 5 were interventional studies. The studies were categorized according to the clinical settings involved in the intrahospital patient transfers. CONCLUSIONS There is consistent evidence on the perceived impact of communication breakdown on patient safety during intrahospital transfers. Exposure of handoffs at patient transfers presents challenges that are not experienced in intershift handoffs. The distinct needs of the specific clinical settings involved in the intrahospital patient transfer must be considered when deciding on suitable interventions.
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Affiliation(s)
- Mei-Sing Ong
- Centre for Health Informatics, University of New South Wales, Sydney, Australia.
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23
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Challenges to inter-departmental coordination of patient transfers: A workflow perspective. Int J Med Inform 2010; 79:112-22. [DOI: 10.1016/j.ijmedinf.2009.11.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2009] [Revised: 11/04/2009] [Accepted: 11/09/2009] [Indexed: 11/18/2022]
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24
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Abstract
Transferring critically ill patients, whether intra- or inter-hospital, is an integral part of the daily working life of intensive care unit staff. It requires a multitude of skills, including thorough patient assessment, rigorous pre-transfer preparation, and constant vigilance throughout the transfer to ensure the safety of the patient. The development of these skills is a fundamental necessity for trainees in critical care. We investigated current critical care trainees' experience of patient transfer in one region in the UK, and assessed their views of their training in patient transfer. The results of our survey demonstrate some worrying conclusions about deficiencies in specific transfer training. We hope to encourage a discussion about the standards in transfer training which are needed and the best way to deliver such training.
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Affiliation(s)
- Caroline Cook
- Specialist Registrar in Anaesthetics and Intensive Care, Southampton University Hospitals NHS Trust
| | - C Allan
- Specialist Registrar in Anaesthetics and Intensive Care, Southampton University Hospitals NHS Trust
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25
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Papson JPN, Russell KL, Taylor DM. Unexpected events during the intrahospital transport of critically ill patients. Acad Emerg Med 2007; 14:574-7. [PMID: 17535981 DOI: 10.1197/j.aem.2007.02.034] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To examine unexpected events (UEs) that occur during the intrahospital transport of critically ill emergency department patients. METHODS This was a prospective observational study of consecutive intrahospital transports between March 2003 and June 2004. The escorting emergency physician completed the data collection document either during or immediately after the transport. This document detailed equipment-related UEs, patient instability and invasive line-related UEs, whether the UEs required intervention, and whether the UEs were potentially life threatening (serious UEs). RESULTS Of 339 transports observed, 230 (67.9%; 95% confidence interval [CI] = 62.6% to 72.7%) were associated with 604 UEs. Overall, there was a median of 1.0 UE per transport (range, 0-16). There were 277 (45.9%; 95% CI = 41.8% to 49.9%) UEs related to equipment, 158 (26.2%; 95% CI = 22.7% to 29.9%) related to patient instability, 156 (25.8%; 95% CI = 22.4% to 29.6%) related to equipment lines, and 13 (2.2%, 95% CI = 1.2% to 3.8%) miscellaneous UEs. The most common UEs were oxygen saturation probe failures, lead and line tangles, hypotension, and the wearing off of sedation and/or paralysis. Most UEs (478 [79.1%]; 95% CI = 75.6% to 82.3%) required an intervention. Emergency physicians had a significantly lower UE rate than residents. Thirty serious UEs occurred; 5.0% (95% CI = 3.4% to 7.1%) of UEs and 8.9% (95% CI = 6.2% to 12.5%) of transports were associated with a serious UE. The most common were severe hypotension, decreasing consciousness requiring intubation, and increased intracranial pressure. CONCLUSIONS Unexpected events during the intrahospital transport of critically ill patients from the emergency department are common and can be potentially life threatening. Transporting physician experience is associated with UE rate. Strict adherence to and review of existing transport guidelines is recommended.
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