Evaluation of Inter-Hospital Patient Referrals From An Academic Emergency Department Perspective: A Retrospective, Observational Study

Abstract

Our study aimed to assess the appropriateness of referral by comparing the reasons for referral, diagnoses, and clinical or intensive care needs of patients admitted to the emergency department. By analyzing the appropriateness of referral, this evaluation aims to develop strategies for efficient patient management and effective management of overcrowding. The data of 4365 patients admitted with referral between 01.07.2022 and 31.07.2023 in the emergency department of our hospital were evaluated retrospectively. The need for referral, medical conditions, consultations requested by the evaluating physician, need for clinical or intensive care hospitalization, length of stay in the emergency department, and emergency department and in-hospital mortality status were evaluated. The need for referral, consultations requested by the evaluating emergency physician, and hospitalization or discharge status of the patients were compared. The most common referral diagnosis was ischemic heart disease (47.9%), which was 81.1% from the district state hospital. This diagnosis was followed by "trauma intoxication, burn diagnosis," and "cerebrovascular diseases". Among the reasons for transfer, the need for a specialist physician was observed at the highest rate. The concordance rate between the diagnosis of arrival (referral diagnosis) and the emergency diagnosis was 48.5%. The rate of subspecialty consultation was 17.6%. Approximately half (47.7%) of the referred patients in the emergency department ended with hospitalization in the intensive care unit. Inter-hospital transfers are critical to ensure that patients receive effective and appropriate treatment, requiring special analysis at each stage. It was determined that 81.1% of the referrals to our hospital were from district state hospitals and the most common diagnosis of referral was ischemic heart disease (47.9%). This diagnosis was followed by "trauma intoxication, burns" and "cerebrovascular diseases". The most common reason for transfers was the need for specialized physicians. For a coordinated health service delivery, it may be decisive to review the need for specialist physicians and hospital capacities in peripheral hospitals.

Keywords

• Inter-hospital referral
• patient transportation requirement
• emergency department

Hastaneler Arası Hasta Sevklerinin Akademik Bir Acil Servis Perspektifinden Değerlendirilmesi: Retrospektif, Gözlemsel Bir Araştırma

Abstract

Araştırmamızın amacı, acil servise sevk ile kabul edilen hastaların sevk nedenleri, konulan tanılar ve klinik ya da yoğun bakım ihtiyaçları üzerinde bir karşılaştırma yaparak sevk gerekliliğinin uygunluğunu değerlendirmektir. Bu değerlendirme, sevk uygunluğunu analiz ederek etkin hasta yönetimi ve yoğunluğun etkili bir şekilde yönetilmesi konusunda stratejiler geliştirmeyi hedeflemektedir. Hastanemiz acil servisinde 01.07.2022-31.07.2023 tarihleri arasında sevk ile kabul edilen 4365 hastaya ait veriler geriye dönük olarak değerlendirildi. Hastaların ilk değerlendirme sonrası belirtilen sevk gereksinimi, tıbbi durumları, hastaların değerlendiren hekim tarafından istenen konsültasyonları, klinik ya da yoğun bakım yatış gereksinimi, acil serviste kalış süresi ve acil servis ve hastane içi mortalite durumu değerlendirildi. Hastaların sevk gereksinimi, hastayı değerlendiren acil tıp uzmanı tarafından talep edilen konsültasyonlar ve hastanın yatış ya da taburculuk durumuna göre karşılaştırılaştırıldı. Sevk sayısının %81,1 oranında en sık ilçe devlet hastanesinden olduğu ve sevk tanıları içinde en fazla iskemik kalp hastalıkları (%4,9) olduğu tespit edildi. Nakil sebepleri içinde en yüksek oranda gözlenen uzman hekim ihtiyacıdır Geliş tanısı (sevk tanısı) ile acil tanısı arasındaki uyumluluk oranı %48,5’ tir. Yan dal konsültasyon oranı ise %17,6 olarak bulundu. Sevk edilen hastaların acil serviste yaklaşık yarısı (%47,7) yoğun bakım ünitesine yatış ile sonlanmıştır. Hastaneler arası nakiller, her bir aşamasında özel bir analiz gerektiren, hastaların etkili ve gerektiği şekilde tedavi almalarını sağlamak için kritik bir öneme sahiptir. Hastanemize yapılan sevk tanıları içinde en fazla iskemik kalp hastalıkları, travma ve intoksiksyonların yer aldığı görüldü. Nakil sebepleri içinde en yüksek oranda gözlenen sebep uzman hekim ihtiyacıdır. Koordineli bir sağlık hizmeti sunumu için perifer hastanelerde uzman hekim ihtiyacının ve hastane kapasitelerinin gözden geçirilmesi belirleyici olabilir.

Keywords

• Hastaneler arası sevk
• hasta nakil gereksinimi
• acil servis

References

1. 1. American College of Cardiology. (2020). Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease. Journal of the American College of Cardiology, 75(25), 3029-3071).
2. 2. Royal College of Surgeons. (2018). Emergency Surgery: Standards for Unscheduled Surgical Care. London: Royal College of Surgeons).
3. 3. National Comprehensive Cancer Network. (2020). NCCN Clinical Practice Guidelines in Oncology: Breast Cancer. Retrieved from https://www.nccn.org/professionals/ physician_gls/default.aspx).
4. 4. Vincent, J. L., & Creteur, J. (2019). Ethical aspects of the COVID-19 crisis: How to deal with an overwhelming shortage of acute beds. European Heart Journal: Acute Cardiovascular Care, 8(3), 208-212).
5. 5. World Health Organization. (2014). Ethical considerations in developing a public health response to pandemic influenza. Geneva: World Health Organization).
6. 6. Kringos, D., & Barbazza, E. (2016). Health workforce governance: processes, tools and actors towards a competent workforce for integrated health services delivery. Health Policy, 120(12), 1276-1284.
7. 7. Dedeilia, A., Sotiropoulos, M. G., Hanrahan, J. G., & Janga, D. (2020). Medical and surgical education challenges and innovations in the COVID-19 era: a systematic review. In Vivo, 34(3_suppl), 1603-1611
8. 8. Stroetmann, V. N., Kubitschke, L., Robinson, S., Stroetmann, K. A., Cullen, K., McDaid, D., ... & Jongsma, K. (2011). How can telehealth help in the provision of integrated care?. Copenhagen: European Commission

9. 9. Pines, J. M., & Venkatesh, A. K. (2011). The role of emergency medicine in the delivery of primary care. Academic Emergency Medicine, 18(11), e27-e34).
10. 10. Kripalani, S., LeFevre, F., Phillips, C. O., Williams, M. V., Basaviah, P., & Baker, D. W. (2007). Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA, 297(8), 831-841)
11. 11. Ertan, C., Akgün, F. S. & Yücel, N. (2010) “Bir Üniversite Hastanesi Acil Servisine Yapılan Sevklerin İncelenmesi”, Türkiye Acil Tıp Dergisi, 10(2): 65–70.
12. 12. GÖNÇER DEMİRAL D, ÖZEN Ü. HASTANELER ARASI HASTA SEVKLERİ: DOĞU KARADENİZ HASTANELERİ ÜZERİNE BİR UYGULAMA. Journal of Management and Economics Research. December 2020;18(4):190-208. doi:10.11611/yead.815880
13. 13. Güler, S., Aksel, G., Ayılgan, F. T., Özkan, H. İ., Baz, Ü., & Orak, Y. (2014) “Evaluation of Emergency Interhospital Patient Transfers from Province of Mardin to Out-of-Province Hospitals in a Year”, The Journal of Academic Emergency Medicine, 13: 62–66.
14. 14. Kılıç, M., Dokur, M. ve Ulutaşdemir, N. (2016) “Acil Hasta Sevklerinde Yaşanan Sorunlar : Küçük Bir İl Düzeyinde Yapılan Değerlendirme”, Zirve Tıp Dergisi, 1(1): 17–21.
15. 15. O'Malley, A. S., Grossman, J. M., Cohen, G. R., Kemper, N. M., Pham, H. H., & Ginsburg, P. B. (2010). Are electronic medical records helpful for care coordination? Experiences of physician practices. Journal of General Internal Medicine, 25(3), 177-185).
16. 16. Institute of Medicine. (2011). Digital Infrastructure for the Learning Health System: The Foundation for Continuous Improvement in Health and Health Care: Workshop Series Summary. Washington, DC: The National Academies Press
17. 17. Vest, J. R., & Gamm, L. D. (2010). Health information exchange: persistent challenges and new strategies. Journal of the American Medical Informatics Association, 17(3), 288-294
18. 18. Adler-Milstein, J., DesRoches, C. M., Furukawa, M. F., Worzala, C., Charles, D., Kralovec, P., ... & Jha, A. K. (2014). More than half of US hospitals have at least a basic EHR, but stage 2 criteria remain challenging for most. Health Affairs, 33(9), 1664-1671
19. 19. O'Donnell, H. C., Patel, V., Kern, L. M., Barrón, Y., Teixeira, P., Dhopeshwarkar, R., ... & Kaushal, R. (2012). Healthcare consumers’ attitudes towards physician and personal use of health information exchange. Journal of General Internal Medicine, 27(7), 720-727
20. 20. Furukawa, M. F., Patel, V., Charles, D., & Swain, M. (2014). Hospital electronic health information exchange grew substantially in 2008-12. Health Affairs, 33(12), 2271-2277