Analysis of Interhospital Emergency Referrals Despite Safety Concerns on the Roads: Emergency Referrals in Northwest Syria intraregional Borders

Year 2024, , 113 - 120, 28.09.2024

Bahadır Karaca , Burak Çelik

https://doi.org/10.54996/anatolianjem.1404434

Abstract

Aim: Our study aims to assess emergency patient transport between hospitals in the northwestern region of Syria. In this way, determining the patient profiles transferred in the region can help shed light on the reasons for avoidable transfers, reduce transfers, and reduce the risks associated with transfers.

Material and Methods: Our retrospective study investigated the patients who were transferred to Azez Vatan Hospital, Çobanbey Hospital, and Jarablus Hospital and from these facilities within the borders of the northwestern region of Syria between 01/01/2020-01/01/2021. Transfer records of patients transferred between hospitals and ambulance stations were searched in files and computer records. Because there was no automation system in the healthcare facilities involved in the study, data were recorded manually on the data collection form and processed for statistical analysis. Statistical analyses of the study were performed as descriptive statistics of variables are reported as mean±standard deviation, median (min-max), and n (%). Statistical analyses of categorical variables were performed using the chi-square test and Fisher Freeman Halton Exact test.

Results: The mean age of the patients of 899 patients included in the study was 33.68±26.80 years, 530(59.0%) were male and 369(41.0%) were female. 27.3% of patients were trauma patients and of both sexes. Male trauma patients were approximately 2.5 times more common than female trauma patients. Among pediatric transfers, trauma was present in one out of every three patients. Patients were most frequently transferred in February, March, and June and least frequently in January (p < 0.05). It was found that the need for adult, newborn, and pediatric intensive care, the need for medical material and equipment, the need for further examination/treatment, followed by the need for treatment under the supervision neurosurgeon, obstetric and gynecologist, cardiology specialist, or pediatrician. It was also noted that transfers for COVID-19 (SARS-CoV-2 Coronavirus Disease 2019) service needs due to the impact of the COVID-19 outbreak during the study period were among the most common reasons. COVID-19 falls, respiratory distress, traffic accidents, and acute MI were the most common diagnoses in all transferred age groups.

Conclusion: In northwestern Syria, emergency patients are most often transferred from one hospital to another because they require all types of intensive care units, medical materials and equipment, advanced diagnostic treatment, and specialists in neurosurgery, obstetrics and gynecology, cardiology, and pediatrics. Increasing hospital capacity and qualifications of hospitals within the humanitarian response and increasing the number of specialists, may be considered to reduce inter-hospital transfers of emergency patients.

Keywords

Emergency transfer, interhospital transfer, post-conflict area, Syria

Ethical Statement

Ethical Approval Institution name: Non-Interventional Clinical Trials Ethics Committee of Hatay Mustafa Kemal University Tayfur Ata Sökmen Faculty of Medicine Approval number: 11 Date, it was received : 18.02.2021

Supporting Institution

non

Thanks

The authors would like to thank the local Syrian health workers and Turkish health consultants working in the region where the study was conducted for their contribution to the data collection. Additionally, the authors would like to thank Prof. Dr. Özkan GORGULU (Kırşehir Ahi Evran University, Faculty of Medicine, Biostatistics and Medical Informatics Department) for his assistance in the statistical analysis of the study.

Güzergahlardaki Güvenlik Endişelerine Rağmen Yapılan Hastaneler Arası Acil Sevklerin Analizi: Kuzeybatı Suriye Bölge İçi Sınırlarda Acil Sevkler

Abstract

Amaç: Bu çalışmada, Suriye'nin kuzeybatı bölgesindeki hastaneler arasındaki acil hasta sevklerini değerlendirmeyi amaçlandı. Bu çalışmayla bölgede sevk edilen hasta profillerinin belirlenmesine, önlenebilir sevk nedenlerinin aydınlatılmasına, sevklerin azaltılmasına ve sevklerden kaynaklanan risklerin azaltılmasına katkı sağlanabilir.

Gereç ve Yöntemler: Bu retrospektif araştırmada, 01/01/2020-01/01/2021 tarihleri arasında Suriye'nin kuzeybatı bölgesi sınırları içindeki Azez Vatan Hastanesi, Çobanbey Hastanesi ve Jerablus Hastanesi'ne sevk edilen ve bu tesislerden sevk edilen hastalar değerlendirildi. Hastanelerdeki ve ambulans istasyonlarındaki hastaların sevk kayıtları dosyalardan ve bilgisayar kayıtlarından araştırıldı. Araştırmaya dâhil edilen sağlık kuruluşlarında otomasyon sistemi bulunmadığından veriler, veri toplama formuna manuel olarak kaydedilerek istatistiksel analizler için kaydedildi. Araştırmanın istatistiksel analizleri değişkenlere ait tanımlayıcı istatistikler ortalama±standart sapma, ortanca (min-maks) ve n (%) olarak raporlanarak yapıldı. Kategorik değişkenlerin istatistiksel analizleri ki-kare testi ve Fisher Freeman Halton Exact testi kullanılarak yapıldı.

Bulgular: Çalışmaya dâhil edilen 899 hastanın yaş ortalaması 33,68±26,80 yıl olup, 530'u (%59,0) erkek, 369'u (%41,0) kadındı. Hastaların %27,3'ü travma hastasıydı. Erkeklerde travma kadın hastalara göre yaklaşık 2,5 kat daha sık görülüyordu. Pediatrik başvurularda her üç hastadan birinde travma mevcuttu. Hastalar en sık Şubat, Mart ve Haziran aylarında, en az ise Ocak ayında başvurdu (p<0,05). Hastaların; erişkin, yenidoğan ve çocuk yoğun bakım ihtiyacı; tıbbi malzeme ve ekipman ihtiyacı, ileri tetkik/tedavi ihtiyacı olduğu ve beyin cerrahı, kadın doğum uzmanı, kardiyoloji veya pediatri uzmanı gözetiminde tedavi ihtiyacı olduğu tespit edildi. Ayrıca çalışma dönemi içerisinde COVİD -19 salgınının etkisiyle oluşan COVİD -19 (SARS-CoV-2 Coronavirüs Hastalığı 2019) hizmet ihtiyaçlarına yönelik sevklerin de en sık görülen nedenler arasında yer aldığı saptandı. Sevk edilen tüm yaş gruplarında en sık görülen tanılar, COVID-19, düşme, solunum sıkıntısı, trafik kazası ve akut miyokard enfarktüsü idi.

Sonuç: Kuzeybatı Suriye'de acil hastalar çoğunlukla acil nedenlerle bir hastaneden diğerine sevk edilebilmektedir. Sevk nedenleri olarak yoğun bakım ünitesinde takip ihtiyacı; tıbbi malzeme ve ekipman ile ileri teşhis tedavi gereksinimi ve beyin cerrahisi, kadın doğum, kardiyoloji ve pediatri uzmanı değerlendirmesine ihtiyaç duyulması görülmektedir. İnsani yardım kapsamında hastane kapasitesinin ve hastanelerin niteliklerinin arttırılması ve uzman sayısının arttırılmasının, acil hastaların hastaneler arası sevkleri azaltacağı düşünülebilir.

Keywords

Acil sevk, hastaneler arası transfer, çatışma sonrası bölge, Suriye

References

• Gedik MS, Hakkoymaz H, Basan NM, Safi Y, Aksay E. Assessment of Service and Social Conditions of 112 Ambulance Workers. KSU Medical Journal. 2022; 17(2): 20-28.
• Kulshrestha A, Singh J. Inter-hospital and intra-hospital patient transfer: Recent concepts. Indian J Anaesth. 2016 Jul;60(7):451-7.
• Beckmann U, Gillies DM, Berenholtz SM, Wu AW, Pronovost P. Incidents relating to the intra-hospital transfer of critically ill patients. An analysis of the reports submitted to the Australian Incident Monitoring Study in Intensive Care. Intensive Care Med. 2004 Aug;30(8):1579-85.
• Rattananon P, Yenyuwadee I, Dheeradilok T. et al. Predictors of Mortality among Inter-Hospital Transferred Patients in a Middle-Income Country: a Retrospective Cohort Study. Siriraj Medical Journal, 2021; 73(5), 312-321.
• Iwashyna TJ, Courey AJ. Guided transfer of critically ill patients: Where patients are transferred can be an informed choice. Curr Opin Crit Care. 2011;17:641–7.
• Gönçer Demiral D, Özen Ü, Analysis of patient transfers between hospitals: An application on East Black Sea Hospitals. Journal of Management and Economics Research, 2020, 18.4: 190-208.
• Hsia RY, Mbembati NA, Macfarlane S, Kruk ME. Access to emergency and surgical care in sub-Saharan Africa: the infrastructure gap, Health Policy and Planning, 2021:27(3).
• Farmer PE, Kim JY. Surgery and Global Health: A View from Beyond the OR. World J Surg 32, 533–536 (2008).
• Kirschner SA, Finaret AB. (2021). Conflict and health: Building on the role of infrastructure. World Development, 146, 105570.
• Earnest J. (2015), "Post-conflict reconstruction – a case study in Kosovo: The complexity of planning and implementing infrastructure projects", International Journal of Emergency Services, Vol. 4 No. 1, pp. 103-128.
• da Silva LA, Pechansky RC, Heck R. Post-conflict reconstruction in the Middle East and North Africa: the cases of Iraq, Libya, and Syria. UFRGSMUN | UFRGS Model United Nations ISSN 2318-3195 | v. 6 2018 |p.410-451 Available from: https://www.ufrgs.br/ufrgsmun/2018/web/files/isdb.pdf (Last accessed on 2022 Dec 03).
• Demir E. Türkiye’nin Suriye politikası bağlamında TSK’nın Suriye’deki sınır ötesi harekâtlarının nedenleri ve sonuçları. Bölgesel Araştırmalar Dergisi. (2021).5(2), 541-580.
• Karaca B, Çelik B. (2022). Can 4C Score Predict Mortality due to COVID-19 Pneumonia in Syria? An Observational Study. Southern Clinics of Istanbul Eurasia, 33(3).
• Crandon IW, Harding HE, Williams EW, Cawich SO. (2008). Inter-hospital transfer of trauma patients in a developing country: A prospective descriptive study. International Journal of Surgery, 6(5), 387-391.
• Adeleye AO, Okonkwo DO. Inter-hospital transfer for neurosurgical management of mild head injury in a developing country: A needless use of scarce resources?. The Indian Journal of Neurotrauma. (2011)8(1), 1-5.
• Shannon EM, Schnipper JL, Mueller SK. Identifying Racial/Ethnic Disparities in Interhospital Transfer: An Observational Study. J GEN INTERN MED 35, 2939–2946 (2020
• Güler S, Aksel G, Ayılgan FT, Özkan Hİ, Baz Ü, Orak Y. Evaluation of Emergency Interhospital Patient Transfers from Province of Mardin to Out-of-Province Hospitals in a Year. Journal of Academic Emergency Medicine/Akademik Acil Tip Olgu Sunumlari Dergisi, (2014). 13(2).
• Kilci Aİ, Hakkoymaz H, Gedik MS, Avsarogullari L, Şenol V, Altuntaş M. Evaluation of Nursing Home Residents Applying to The Emergency Service. Eurasian Journal of Critical Care. 2022; 4(2): 63-69
• Gattu RK, Teshome G, Cai L, Wright C, Lichenstein R. Interhospital Pediatric Patient Transfers—Factors Influencing Rapid Disposition After Transfer. Pediatric Emergency Care (2014).30(1): 26-30.
• Odetola FO, Shanley TP, Gurney JG, Clark SJ, Dechert RE, Freed GL. et al. Characteristics and outcomes of interhospital transfers from level II to level I pediatric intensive care units*. Pediatric Critical Care Medicine 7(6):p 536-540, November 2006.
• Sabzehei MK, Basiri B, Shoukohi M, Torabian S, Razavi Z. Factors affecting the complications of interhospital transfer of neonates transferred to the Neonatal Intensive Care Unit of Besat Hospital in 2012–2013. J Clin Neonatol 2016;5:238-42.
• Kumar PP, Kumar CD, Shaik FA, Ghanta SB, Venkatalakshmi A. Prolonged neonatal interhospital transport on road: Relevance for developing countries. Indian J Pediatr 77, 151–154 (2010).
• Çelik N, Karaca B. Celik B, Bereket N., Korkmaz S. Evaluation of North Syrian Women Knowledge, Opinions and Attitudes Regarding Milk Banks and Milk Donation. Konuralp Medical Journal, (2022). 14(2), 366-372.
• Burstein B, Bibas L, Rayner-Hartley E, Jentzer JC, van Diepen S, Goldfarb M. National interhospital transfer for patients with acute cardiovascular conditions. CJC open, 2020; 2(6), 539-546.
• Kim MS, Choi SH, Bae JW, Lee J, Kim H, Lee WK. Did inter-hospital transfer reduce mortality in patients with acute myocardial infarction in the real world? A nationwide patient cohort study. Plos one, 2021; 16(8), e0255839.
• Westfall JM. Transfer as Treatment in Rural Hospitals. JAMA Netw Open. 2024;7(3):e241845.
• Yohann A, Kajombo C, Mulima G, Gallaher J., Charles A. Inter-hospital Transfer Delays to a Tertiary Referral Center and Postoperative Outcomes in Patients with Abdominal Surgical Emergencies in Malawi. World Journal of Surgery, 2022;46(9), 2085-2093.
• Shannon EM, Schnipper JL, Mueller SK. Identifying racial/ethnic disparities in interhospital transfer: an observational study. Journal of General Internal Medicine, 2020; 35, 2939-2946.