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Anwar H, Harthi TA, Jaafar N, Shuraiqi FA, Afifi N, Abri KA, Rujaibi SA, Ghafri TA. Appropriateness of the Emergency Referrals Made by Primary Care Clinicians: A cross-sectional review of referral notes. Sultan Qaboos Univ Med J 2024; 24:28-36. [PMID: 38434471 PMCID: PMC10906761 DOI: 10.18295/squmj.9.2023.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/15/2023] [Accepted: 07/19/2023] [Indexed: 03/05/2024] Open
Abstract
Objectives This study aimed to evaluate the appropriateness of the emergency referrals made by primary care clinicians and determine the factors contributing to inappropriate referrals. Methods This cross-sectional study utilises referral notes review between October 2019 and March 2020. Patients referred to Khawla Hospital's emergency department by a primary care clinician in Muscat Governorate were randomly selected; their referral notes were reviewed by five family physicians. The appropriateness of the referrals was evaluated according to the primary care referral protocol. Any referral that deviated from the protocol was classified as inappropriate. The prevalence and characteristics of inappropriate referrals were identified, and the factors contributing to inappropriate referral were determined using multivariable logistic regression. Results In total, 591 referrals were reviewed; 354 (59.9%) of them were classified as inappropriate due to inadequate medical notes (291, 82.2%), lack of provisional diagnosis (176, 49.7%), misdirected to a non-concerned emergency (30, 8.4%) or misclassification of urgency (107 [30.2%] were classified as urgent and 45 [12.7%] as routine). After adjusting for multiple variables, insufficient clinical notes, unavailability of referral guidelines and lack of expertise were found to be strong determinants of inappropriate referral, with an odds ratio of 62.52 (95% confidence interval [CI]: 32.04-121.96), 2.88 (95% CI: 1.40-5.92) and 9.37 (95% CI: 4.09-21.43), respectively. Conclusion While most of the referrals required emergency management, the majority were inappropriate, mainly due to insufficient clinical documentation. Inadequate clinical notes and lack of national guidelines and expertise were found to be strong predictors of inappropriate emergency referrals.
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Affiliation(s)
- Huda Anwar
- Family Medicine, Hai Al Mina Health Center, Directorate General of Health Care Services, Muscat, Oman
| | - Thuraiya Al Harthi
- Research Unit, Directorate of Training and Studies, The Royal Hospital, Muscat, Oman
| | - Najlaa Jaafar
- Family Medicine, Al Wataya Health Center, Directorate General of Health Services, Muscat, Oman
| | - Fathiya Al Shuraiqi
- Family Medicine, Al Mawaleh North Health Center, Directorate General of Health Services, Muscat, Oman
| | - Nihal Afifi
- General Practice, Department of School Health, Directorate General of Health Services, Muscat, Oman
| | - Khadeeja Al Abri
- Family Medicine, Al Shadi Health Center, Directorate General of Health Services, Muscat, Oman
| | - Salha Al Rujaibi
- Family Medicine, Hai Al Jame Health Center, Directorate General of Health Services, Muscat, Oman
| | - Thamra Al Ghafri
- Public Health, Directorate General of Health Services, Muscat, Oman
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Cardozo Ocampo A, García Pareja MA, Serrano Rojas CA, Grajales Osorio N. Seguridad en urgencias sobre la referencia de pacientes no urgentes a centros de atención primaria. Repert Med Cir 2023. [DOI: 10.31260/repertmedcir.01217372.1285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Objetivos: determinar la seguridad al referir pacientes triage 4 y 5 desde un servicio de urgencias a centros de atención primaria, conociendo su disposición final y las posibles complicaciones por esta estrategia. Métodos: estudio observacional retrospectivo de 333 pacientes clasificados como triage 4 y 5 que fueron referidos desde el servicio de urgencias a un centro de atención primaria en febrero 2019. A través de la aseguradora se obtuvo la información sobre si asistieron o no a dicha cita programada y la conclusión final de la consulta. Resultados: 52 pacientes (15,6%) no asistieron a la cita programada sin que esto causara alguna complicación para su salud. De los 281 que sí asistieron, 1,4% fueron referidos a valoración especializada urgente sin que requirieran ingreso hospitalario y 98,6% fueron atendidos y manejados en forma ambulatoria por el médico de atención primaria. Se encontraron diferencias entre los no asistentes a la atención primaria en los subgrupos de edad entre 3 a 17 (p=0,009) y 18 a 37 años (p=0,04). Conclusiones: la estrategia de referencia de pacientes clasificados en 4 o 5 desde un servicio de urgencias a centros de atención primaria es segura, incluso si estos no asisten a la cita programada.
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Takeuchi S, Minami M, Asabe Y, Miyauchi M, Suganuma N, Nishiyama K. Impact of school closures on pediatric ambulance transport in Japan. Pediatr Int 2023; 65:e15427. [PMID: 36445005 DOI: 10.1111/ped.15427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 11/01/2022] [Accepted: 11/28/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND After the coronavirus disease (COVID-19) pandemic, nationwide school closures were implemented in many countries. This study aimed to determine the impact of the school closures on pediatric ambulance transport, comparing the situation before and after the COVID-19 pandemic. METHODS This retrospective observational study was conducted using data from the Kochi-Iryo.net database. In Kochi prefecture, schools were closed from March 6 to May 24, 2020. Pediatric emergency transport during the school closure period in 2020 was compared with that in the same period in 2019 (before the COVID-19 pandemic) and in 2021 (when schools were not closed). Statistical analysis comprised χ2 tests with Bonferroni adjustments for multiple testing. To adjust for patient backgrounds, we also performed multiple logistic regression analyses for numbers of pediatric ambulance transports. RESULTS The rate of pediatric ambulance transports was significantly lower (p = 0.008) in 2020 (276; 3.97%) than in 2019 (391; 4.87%), but there was no significant difference (p = 0.360) between 2019 (391; 4.87%) and 2021 (352; 4.56%). Multivariable analysis revealed similar trends (2019 vs. 2020: OR 0.86, 95% CI 0.73-1.00; 2019 vs. 2021: OR 0.96, 95% CI 0.82-1.11). Regarding the characteristics of pediatric ambulance transport journeys, there were no significant differences in 2019, 2020, and 2021 in terms of sex, severity, locations of ambulance stations, and disease classification. CONCLUSIONS There was a decrease in pediatric ambulance transportation due to the public health interventions for COVID-19, including school closures. However, this decrease was not solely due to school closures.
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Affiliation(s)
- Shinya Takeuchi
- Department of Disaster and Emergency Medicine, Kochi Medical School, Nankoku, Kochi, Japan
| | - Marina Minami
- Integrated Center for Advanced Medical Technologies, Kochi Medical School, Nankoku, Kochi, Japan
| | - Yuina Asabe
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Masato Miyauchi
- Department of Disaster and Emergency Medicine, Kochi Medical School, Nankoku, Kochi, Japan
| | - Narufumi Suganuma
- Integrated Center for Advanced Medical Technologies, Kochi Medical School, Nankoku, Kochi, Japan
| | - Kingo Nishiyama
- Department of Disaster and Emergency Medicine, Kochi Medical School, Nankoku, Kochi, Japan
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Weigert RM, McMichael BS, VanderVelden HA, Lee DB, Cutler GJ, Troy MF, Bergmann KR. Parental Childhood Adversity and Pediatric Emergency Department Utilization: A Pilot Study. Pediatr Emerg Care 2022; 38:665-71. [PMID: 36375010 DOI: 10.1097/PEC.0000000000002875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Adverse childhood experiences (ACEs) including physical, emotional, or sexual abuse; neglect; and/or exposure to household instability have been associated with adult emergency department utilization, but the impact of parental ACEs on pediatric emergency department (PED) utilization has not been studied. The primary aim was to determine if parental ACEs impact resource utilization as measured by (1) frequency of PED utilization, (2) acuity of PED visits, and (3) 72-hour PED return rates. The secondary aim was to determine if resilience interacts with the impact of parental ACEs on PED utilization. METHODS This study is a cross-sectional survey using previously validated measures of ACEs, resiliency, and social determinants of health screening. Surveys were administered from October 17, 2019, to November 27, 2019, via iPad by research assistants in our institution's PEDs. Survey responses were linked to data abstracted from the electronic health record. Descriptive statistics were used to characterize our study population. Pearson correlation was used to identify correlation between ACEs, social determinants of health, and PED utilization measures. RESULTS A total of 251 parents had complete data. Parental ACEs were positively associated with frequency of PED visits (incidence rate ratio, 1.013). In addition, high levels of parental resilience attenuated the association between parental ACEs and the number of severe acuity visits and were associated with fewer 72-hour return visits (incidence rate ratio, 0.49). CONCLUSIONS Parental ACEs appear to be positively associated with frequency of PED utilization and inversely associated with higher-acuity PED visits and parental resiliency.
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Toloo GS, Lim D, Chu K, Kinnear FB, Morel DG, Wraith D, FitzGerald G. Acceptability of emergency department triage nurse's advice for patients to attend general practice: A cross-sectional survey. Emerg Med Australas 2021; 34:376-384. [PMID: 34788904 DOI: 10.1111/1742-6723.13903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Demand for ED care is increasing at a rate higher than population growth. Strategies to attenuate ED demands include diverting low-acuity general practice-type ED attendees to alternate primary healthcare settings. The present study assessed the ED attendees' receptiveness to accept triage nurse's face-to-face advice to explore alternate options for medical care and what factors influence the level of acceptance. METHODS The ED attendees of four major public hospital EDs in Brisbane were surveyed between August and October 2018, using a questionnaire informed by Health Belief Model's cues to action. RESULTS Of the 514 valid responses, 81% of respondents were very likely/likely to accept the triage nurse's advice to see a general practitioner. Self-perceived urgency of presenting condition/s (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.78-0.97), not having confidence in general practitioner (OR 0.37, 95% CI 0.21-0.66) and having a medical record at the hospital (OR 0.60, 95% CI 0.36-0.99) were negatively associated with the likelihood of accepting the advice. For every point increase in perceived seriousness, the odds of accepting the advice decreased by 16% (95% CI 6-25%). CONCLUSION Most of the participants believed that EDs were for emergent care and they attended the ED because they perceived their presenting condition/s to be serious and/or urgent. The acceptability of face-to-face advice by triage nurse to seek help in general practice was influenced by perceived threats of the illness, and the underlying beliefs about availability, accessibility, suitability and affordability of the service.
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Affiliation(s)
- Ghasem Sam Toloo
- School of Public Health and Social Work, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David Lim
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Kevin Chu
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Frances B Kinnear
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Emergency Medicine and Children's Service, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Douglas G Morel
- Emergency Department, Redcliffe Hospital, Brisbane, Queensland, Australia
| | - Darren Wraith
- School of Public Health and Social Work, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Gerry FitzGerald
- School of Public Health and Social Work, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
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El-Masri M, Bornais J, Omar A, Crawley J. Predictors of Nonurgent Emergency Visits at a Midsize Community-Based Hospital System: Secondary Analysis of Administrative Health Care Data. J Emerg Nurs 2020; 46:478-487. [DOI: 10.1016/j.jen.2020.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/31/2020] [Accepted: 02/01/2020] [Indexed: 12/01/2022]
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Yazaki H, Nishiura H. Ambulance Transport of Patients with Mild Conditions in Hokkaido, Japan. Int J Environ Res Public Health 2020; 17:ijerph17030919. [PMID: 32024234 PMCID: PMC7037900 DOI: 10.3390/ijerph17030919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/25/2020] [Accepted: 02/01/2020] [Indexed: 11/16/2022]
Abstract
Understanding the epidemiological distributions of ambulance transport for patients with mild conditions according to age, disease, and geographic region could help in achieving optimal use of ambulance services. In the present study, we explored the descriptive epidemiology of ambulance transports in Hokkaido, the northernmost prefecture of Japan, identifying potential factors that determine the frequency of transports for mild diseases. Of the total 153,667 ambulance transports in Hokkaido during 2016, we found that two-thirds were for older people, of which about 60% resulted in hospital admission. There were 74,485 transports for mild cases, which were most commonly for psychiatric disorders among working-age adults (n = 4805), heart diseases among older people (n = 4246), and sensory organ diseases among older people (n = 3589). Examining the ecological correlations over 58 geographic units of ambulance services, the total unemployment rate and distance to the nearest tertiary care hospital were, respectively, positively and negatively correlated with the standardized transport ratio for multiple mild diseases. The proportion of working-age adults was uniquely identified as a possible positive predictor in mild cases of psychiatric disorders. As the identified potential predictors could be helpful in considering countermeasures, the causal links should be examined in future studies.
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Affiliation(s)
- Hiroshi Yazaki
- Graduate School of Medicine, Hokkaido University, Kita 15-Jo Nishi 7-Chome, Kita-ku, Sapporo-shi, Hokkaido 060-8638, Japan
- Hosanna Family Clinic, Miyanosawa 3 Jo 3-6-1, Nishiku, Sapporo 0630053, Japan
| | - Hiroshi Nishiura
- Graduate School of Medicine, Hokkaido University, Kita 15-Jo Nishi 7-Chome, Kita-ku, Sapporo-shi, Hokkaido 060-8638, Japan
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