TY - JOUR T1 - Hastane İçi Alanlardan Çocuk Acil Servisine Yönlendirilen Hastaların Değerlendirilmesi TT - Evaluation of Patients Directed from In-Hospital Areas to Pediatric Emergency Department AU - Gümüştekin Bilgin, Seda AU - Akça, Halise AU - Kurt, Funda AU - Akca Çağlar, Ayla AU - Akcan Yıldız, Leman AU - Şenel, Saliha AU - Karacan, Can Demir PY - 2025 DA - May Y2 - 2025 DO - 10.70852/tmj.1670291 JF - Turkish Medical Journal JO - TMJ PB - Ankara Yıldırım Beyazıt Üniversitesi Yenimahalle Eğitim ve Araştırma Hastanesi WT - DergiPark SN - 3023-8196 SP - 47 EP - 54 VL - 10 IS - 2 LA - tr AB - Amaç: Hastane içi ve hastaneler arası hasta transferi, genellikle hastanın mevcut yönetimini iyileştirmek için yapılan hasta bakımının önemli bir bölümüdür. Bu çalışmada hastane içi alanlardan çocuk acile yönlendirilen hastaların klinik ve transfer özellikleri ile acil servis müdahale ihtiyaçlarının belirlenmesi amaçlanmıştır. Yöntem: Çalışmaya 1 Nisan-1 Ağustos 2022 tarihleri arasında Çocuk Acil Kliniğine hastane içi bölümlerden yönlendirilen hastalar alındı. Hastaların demografik özellikleri, yönlendiren poliklinik, yönlendirilme nedenleri, bilgilendirme durumu ve yöntemi, hastanın geliş şekli, aciliyet durumu, acilde kalış süresi, uygulanan müdahaleler ve tedavi sonlanım durumu kaydedildi. Bulgular: Çalışmaya 503 hasta dahil edildi. Hastaların 306 (%60,8)’sı erkek, ortalama yaş 76.4 ± 64.3 aydı. Hastaları acile yönlendiren polikliniklerin başında genel pediatri (%26,0) ve alerji poliklinikleri (%19,3) bulunmaktaydı. Bilgilendirme notu yazılma oranı %75,9, telefonla iletişime geçilme oranı %19,3’tü. Yönlendirme nedenleri sıklıkla kısa süreli tedavi ve izlem (%36,0) ve vital bulgu anormalliği (%9,9) idi. Hastaların triyaj düzeyleri Acil Ciddiyet İndeksi (ESI)’ne göre değerlendirildiğinde %13,9 hastanın ESI-5, %52,9 hastanın ESI-4, %25,0 hastanın ESI-3, %4,2 hastanın ESI-2 ve %3,9 hastanın ESI-1 kategorisinde olduğu saptandı. Acil Servis müdahalelerinden monitörizasyon ve oksijen tedavisi kullanma oranları ESI düzeyiyle ilişkiliydi. Parenteral tedavi yapılan 175 hastanın 101 tanesi ESI-3 kategorisindeydi. Acil Serviste ortalama takip süresi 3,9±6,8 saat, hastaların büyük çoğunluğu ≤8 saat (%90,7) takip edilmişti. Acil serviste takip süresi ESI düzeyi ile korele şekilde uzuyordu. Tedavi sonlanım durumunda hastaların büyük çoğunluğu (423 hasta, %84,1) acil servisten taburcu edildi. Hastane yatış oranı ESI-1 ve ESI-2 kategorisinde fazlaydı. Tartışma: Durumu stabil olmayan çocuk hastaların gereksinim duydukları acil tedaviye en kısa sürede ulaşabilmeleri için yönlendiren hekimin hasta transferini doğru organize etmesi; klinik görüş ve tedavi planlarını transfer öncesinde sözlü ve yazılı olarak belirtmesi; acil servis hekimleri ile koordinasyon sağlayarak hareket etmesi önerilmektedir. Hasta güvenliği ve sonuçlarının iyileştirilmesi açısından bu konuya özen gösterilmesinin ve hasta transfer protokollerinin geliştirilmesinin gerektiğini düşünmekteyiz. KW - Çocuk Acil Servis KW - Hasta Taşıma Güvenliği KW - Hastane İçi Transfer KW - Triyaj N2 - Objective: Intra-hospital and inter-hospital patient transfers are crucial components of patient care, often conducted to improve ongoing management. This study aimed to evaluate the clinical and transfer characteristics of pediatric patients referred to the emergency department from in-hospital units and to assess their needs for emergency intervention. Methods: This study included patients referred to the Pediatric Emergency Department from in-hospital units between April 1 and August 1, 2022. Data collected included patient demographics, referring unit, reason for referral, notification to the emergency department and communication method, mode of arrival, urgency level, length of stay in the emergency department, interventions performed, and treatment outcomes. Results: A total of 503 patients were included; 306 (60.8%) were male, with a mean age of 76.4 ± 64.3 months. The most common referring units were general pediatrics (26.0%) and allergy clinics (19.3%). A written referral note was available in 75.9% of cases, while telephone communication occurred in 19.3%. The most frequent referral reasons were short-term treatment and observation (36.0%) and abnormal vital signs (9.9%). Triage levels based on the Emergency Severity Index (ESI) were: ESI-5 in 13.9%, ESI-4 in 52.9%, ESI-3 in 25.0%, ESI-2 in 4.2%, and ESI-1 in 3.9% of patients. Use of monitoring and oxygen therapy was significantly associated with ESI level. Of 175 patients who received parenteral treatment, 101 were in the ESI-3 category. The mean length of stay in the emergency department was 3.9 ± 6.8 hours, with 90.7% of patients monitored for ≤8 hours. The length of stay was positively correlated with ESI level. Most patients (84.1%) were discharged, while hospitalization was more common in ESI-1 and ESI-2 categories. Discussion: To ensure that unstable pediatric patients receive timely emergency care, referring physicians must coordinate transfers effectively. This includes providing both verbal and written clinical assessments and treatment plans and maintaining communication with emergency department physicians. Enhancing coordination during patient transfers and establishing standardized protocols may significantly improve patient safety and clinical outcomes. CR - Akın, F., Tekerek, N. Ü., Arslan, M., et al. (2022). Implementation of an intrahospital transfer protocol for critically ill pediatric patients: Quality improvement project. Journal of Pediatric Intensive Care, 11(4), 309–315. https://doi.org/10.1055/s-0041-1731312 CR - American Academy of Pediatrics Committee on Pediatric Emergency Medicine, American College of Emergency Physicians Pediatric Emergency Medicine Committee, & Emergency Nurses Association Pediatric Committee. (2016). Handoffs: Transitions of care for children in the emergency department. Pediatrics, 138(5), e20162680. https://doi.org/10.1542/peds.2016-2680 CR - American College of Emergency Physicians. (1990). Principles of appropriate patient transfer. Annals of Emergency Medicine, 19(3), 337–338. CR - Arora, V., Johnson, J., Lovinger, D., Humphrey, H. J., & Meltzer, D. O. (2005). Communication failures in patient sign-out and suggestions for improvement: A critical incident analysis. Quality and Safety in Health Care, 14(6), 401–407. https://doi.org/10.1136/qshc.2005.015107 CR - Bigham, M. T., Logsdon, T. R., Manicone, P. E., et al. (2014). Decreasing handoff-related care failures in children’s hospitals. Pediatrics, 134(2). http://www.pediatrics.org/cgi/content/full/134/2/e572 CR - Burgess, J. E., Gall, M., Orr, S., & Kilbey, S. (2017). Formation of Defence Primary Healthcare: A new way of delivering firm base primary healthcare. Journal of the Royal Army Medical Corps, 163(2), 89–93. https://doi.org/10.1136/jramc-2015-000585 CR - Choi, H. K., Shin, S. D., Ro, Y. S., Kim, D. K., Shin, S. H., & Kwak, Y. H. (2012). A before- and after-intervention trial for reducing unexpected events during the intrahospital transport of emergency patients. American Journal of Emergency Medicine, 30(8), 1433–1440. CR - Demirkıran, G., Çakmak, A., & Savaş, T. (2022). Bir üniversite hastanesinde pediatrik intrahospital transport uygulamalarına yönelik retrospektif analiz. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi, 13(4), 534–541. https://doi.org/10.31067/acusaglik.1013527 CR - Fanelli, V., Demoule, A., Montiel, V., et al. (2023). Safety of intrahospital transport of critically ill patients with COVID-19 using dedicated paramedics: A retrospective cohort study. BMC Emergency Medicine, 23(1), 13. https://doi.org/10.1186/s12873-023-00787-w CR - Gallegos, A., Prasad, V., & Lowe, C. G. (2018). Pediatric emergency transport: Communication and coordination are key to improving outcomes. Pediatric Emergency Medicine Practice, 15(4), 1–20. CR - Güleryüz, O. (2022). In-hospital pediatric patient transfers to the pediatric emergency department. Cukurova Medical Journal, 47(1), 332–340. https://doi.org/10.17826/cumj.993559 CR - Günlemez, A., Doğan, P., & Oğuz, S. (2023). Pediatrik acil ve yoğun bakım ünitelerinde hasta güvenliği: Türkiye’de mevcut durum ve gelecek perspektifleri. Türk Yoğun Bakım Dergisi, 21(2), 89–96. https://doi.org/10.4274/tybd.galenos.2023.91979 CR - Gunnarsson, T., Friðriksdóttir, J., Hjálmarsdóttir, M. Á., et al. (2023). Improving communication and handover of patient information between critical care teams: A quality improvement project. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 31(1), 13. https://doi.org/10.1186/s13049-023-  01066-0 CR - Haydar, B., Baetzel, A., Elliott, A., et al. (2020). Adverse events during intrahospital transport of critically ill children: A systematic review. Anesthesia & Analgesia, 131(4), 1135–1145. https://doi.org/10.1213/ANE.0000000000004585 CR - Huy, T., Lowrie, L., Flood, R., et al. (2021). Improving the safety of an emergency department-based direct admission process at a children’s hospital. Pediatric Emergency Care, 37(12), e861–e865. https://doi.org/10.1097/PEC.0000000000002261 CR - Kumari, S., & Kumar, S. (2014). Prevention of unexpected events and patient safety during intrahospital transport of critically ill ICU patients. Indian Journal of Critical Care Medicine, 18(9), 636. CR - Lim, C. E. D., Oh, R. R. Y., Heng, J. J. W., & Ng, Y. Y. (2022). The use of pediatric emergency transport scores for critically ill pediatric patients: A systematic review. Pediatric Emergency Care, 38(6), e1481–e1487. https://doi.org/10.1097/PEC.0000000000002568 CR - Ong, M. S., & Coiera, E. (2011). A systematic review of failures in handoff communication during intrahospital transfers. Joint Commission Journal on Quality and Patient Safety, 37(6), 274–284. https://doi.org/10.1016/s1553-7250(11)37035-3 CR - Ramnarayan, P., Evans, R., Draper, E. S., et al. (2023). Effect of specialist advice via a critical care transport team on outcomes for critically ill children referred to pediatric intensive care: A randomized clinical trial. JAMA, 329(10), 830–840. https://doi.org/10.1001/jama.2023.0167 CR - Şahin, S., Düzkaya, D. S., Yakut, T., & Ceylan, B. (2022). Pediatric nurses’ perspectives on intrahospital transport of critically ill children: A qualitative study. Journal of Pediatric Nursing, 64, e24–e30. https://doi.org/10.1016/j.pedn.2022.01.011 CR - Topal, B., Budak, Y. U., Gok, G., et al. (2023). A multi-center research on PEWS (Pediatric Early Warning Score) usage of pediatric emergency patients: A pilot study in Turkey. Turkish Journal of Pediatrics, 65(1), 96–104. https://doi.org/10.24953/turkjpediatr.2022.3307 CR - Uslu, Y., & Kapucu, S. (2023). Improving the safety of critically ill patients during intrahospital transport: A systematic review. Journal of Critical Care Nursing, 16(2), e130538. https://doi.org/10.5812/ccn-130538 CR - Warren, J., Fromm, R. E., Jr., Orr, R. A., Rotello, L. C., & Horst, H. M. (2004). Guidelines for the inter- and intrahospital transport of critically ill patients. Critical Care Medicine, 32(1), 256–262. https://doi.org/10.1097/01.CCM.0000104917.39204.0A UR - https://doi.org/10.70852/tmj.1670291 L1 - https://dergipark.org.tr/tr/download/article-file/4746495 ER -