Araştırma Makalesi
BibTex RIS Kaynak Göster

Bir Acil Servisten Yapılan Dış Sevklerin Analizi

Yıl 2025, Cilt: 8 Sayı: 3, 128 - 133, 30.09.2025
https://doi.org/10.54996/anatolianjem.1496484

Öz

Amaç: Bu çalışmanın amacı, bir üniversite hastanesi acil servisinden (AS) diğer sağlık kurumlarına sevk edilen hastaların özelliklerini ve sonuçlarını belirlemektir.
Gereç ve Yöntemler: Bu çalışma, 1 Ocak 2011 – 31 Aralık 2012 tarihleri arasında Acil Servise (AS) başvuran ve çeşitli nedenlerle başka bir kuruma sevk edilen erişkin hastaların özelliklerini ve sonuçlarını incelemiştir.
Bulgular: İki yıllık dönemde AS’ye başvuran 164.810 hastadan, dahil edilme kriterlerini karşılayan 429 (%0,26) hasta çalışmaya alındı. Sevklerin en sık nedeni yoğun bakım yatağı bulunmaması (%51) idi. En yaygın tıbbi sorun solunum sistemi hastalıklarıydı (%49). Hastaların sevk edilmeden önce acil serviste kalış süresi ortalama 39 saat (1–360 saat) olarak bulundu. Sevklerin çoğu ambulans ile yapıldı (n=368, %86). Nakiller sırasında kardiyopulmoner arrest gelişmedi ve kardiyopulmoner resüsitasyon (KPR) uygulanmadı. Hastaların %26’sı sevk edildikleri kurumlarda hayatını kaybetti. Bu ölümlerin yalnızca %2,6’sı transferden sonraki ilk 24 saatte gerçekleşti.
Sonuç: Bu çalışma, üçüncü basamak bir acil servisten yapılan sevk oranının düşük olduğunu, sevklerin en yaygın tıbbi nedeninin solunum sistemi hastalıkları, en yaygın idari nedeninin ise yoğun bakım yatağı yetersizliği olduğunu göstermiştir. Sevk edilen hastaların ölümlerinin büyük çoğunluğu, transferden 24 saatten daha uzun bir süre sonra meydana gelmiştir.

Kaynakça

  • Liu L, Liu C, Duan Z, Pan J, Yang M. Factors associated with the inter-facility transfer of inpatients in Sichuan province, China. BMC Health Serv Res. 2019;19(1):1-11. doi:10.1186/s12913-019-4153-7.
  • Gray A, Gill S, Airey M, Williams R. Descriptive epidemiology of adult critical care transfers from the emergency department. Emerg Med J. 2003;20(3):242-246. doi:10.1136/emj.20.3.242.
  • Appropriate Interfacility Patient Transfer. Ann of Emerg Med. 2016;67(5):690-690. doi: 10.1016/j.annemergmed.2016.03.013.
  • Stolte E, Iwanow R, Hall C. Capacity-related interfacility patient transports: patients affected, wait times involved and associated morbidity. CJEM. Jul 2006;8(4):262-8. doi:10.1017/s1481803500013816.
  • Melkun ET, Ford C, Brundage SI, Spain DA, Chang J. Demographic and Financial Analysis of EMTALA Hand Patient Transfers. Hand (New York, NY). 2010/3// 2010;5(1):72-6. doi:10.1007/s11552-009-9214-7.
  • Nacht J, MacHt M, Ginde AA. Interhospital Transfers from U.S. Emergency Departments: Implications for Resource Utilization, Patient Safety, and Regionalization. Acad Emerg Med. 2013/9// 2013;20(9):888-893. doi:10.1111/acem.12209.
  • Sampalis JS, Denis R, Lavoie A, et al. Trauma care regionalization: a process-outcome evaluation. J Trauma. 1999 Apr;46(4):565-79; discussion 579-81. doi: 10.1097/00005373-199904000-00004.
  • Kindermann DR, Mutter RL, Cartright-Smith L, Rosenbaum S, Pines JM. Admit or transfer? the role of insurance in high-transfer-rate medical conditions in the emergency department. Ann of Emerg Med. 2014;63(5):561-571.e8. doi: 10.1016/j.annemergmed.2013.11.019.
  • Roche-Nagle G, Bachynski K, Nathens AB, Angoulvant D, Rubin BB. Regionalization of services improves access to emergency vascular surgical care. Vascular. 2013/4// 2013;21(2):69-74. doi:10.1177/1708538113478726.
  • Eckstein M, Schlesinger SA, Sanko S. Interfacility Transports Utilizing the 9-1-1 Emergency Medical Services System. Prehosp Emerg Care. 2015/10// 2015;19(4):490-495. doi:10.3109/10903127.2015.1005258.
  • Gupta K, Mueller SK. Interhospital transfers: The need for standards. J Hosp Med. 2015 Jun;10(6):415-7. doi: 10.1002/jhm.2320. Epub 2015 Jan 28.
  • Mueller SK, Shannon E, Dalal A, Schnipper JL, Dykes P. Patient and Physician Experience with Interhospital Transfer: A Qualitative Study. J Patient Saf. 2021 Dec 1;17(8):e752-e757. doi: 10.1097/PTS.0000000000000501.
  • Golestanian E, Scruggs JE, Gangnon RE, Mak RP, Wood KE. Effect of interhospital transfer on resource utilization and outcomes at a tertiary care referral center. Crit Care Med. 2007 Jun;35(6):1470-6. doi: 10.1097/01.CCM.0000265741.16192.D9.
  • Nirula R, Maier R, Moore E, Sperry J, Gentilello L. Scoop and run to the trauma center or stay and play at the local hospital: hospital transfer's effect on mortality. J Trauma. 2010 Sep;69(3):595-9; discussion 599-601. doi: 10.1097/TA.0b013e3181ee6e32
  • Naval NS, Chang T, Caserta F, Kowalski RG, Carhuapoma JR, Tamargo RJ. Impact of pattern of admission on outcomes after aneurysmal subarachnoid hemorrhage. J Crit Care. 2012 Oct;27(5):532.e1-7. doi: 10.1016/j.jcrc.2012.03.006.
  • Republic of Turkey Ministry of Health, General Directorate of Health Services. Circular on the Classification of Healthcare Providers (General Letter No. 2019/10). Internet. Available at: https://khgm.saglik.gov.tr/TR-102784/saglik-hizmeti-sunucularinin-basamaklandirilmasi-hakkinda-genelge--201910.html. Accessed 30 September 2025.
  • General Directorate of Public Hospitals. Public Hospitals Statistics Report 2017. Internet. Available at: https://dosyamerkez.saglik.gov.tr/Eklenti/21853/0/kamu-hastaneleri-istatistik-raporu--2017pdf.pdf. Accessed 30 March 2025.
  • Republic of Turkey Official Gazette. Yataklı Sağlık Tesislerinde Acil Servis Hizmetlerinin Uygulama Usul ve Esasları Hakkında Tebliğ. (Published 16 October 2009; Issue No. 27378). Internet. Available at: https://www.istanbulsaglik.gov.tr/w/sb/ash/belge/saglik_bakanligi.pdf. Accessed 30 March 2025.
  • Republic of Turkey Official Gazette. Yataklı Sağlık Tesislerinde Acil Servis Hizmetlerinin Uygulama Usul ve Esasları Hakkında Tebliğ — Amendment. (Published 13 September 2022; Issue No. 31952; with further amendments 11 October 2024; Issue No. 32689). Internet. Available at: https://www.resmigazete.gov.tr/eskiler/2023/05/20230513-8.htm. Accessed 30 March 2025.
  • Ertan C, Akgün FS, Yücel N. Bir Üniversite Hastanesi Acil Servisine Yapılan Sevklerin İncelenmesi. Turk J Emerg Med. 2010;10(January):65-70.
  • Atilla Duman Ö, Oray D, Akin Ş, Acar K, Bi̇lge A. An Emergency Department perspective: Ambulance transfers and referral consents of the patients. Turk J Emerg Med. 2010;10(4):175-180.
  • Republic of Turkey Ministry of Health, İzmir Provincial Directorate of Health. Healthcare Facilities (Sağlık Tesisleri). Internet. Available at: https://izmirism.saglik.gov.tr/TR-134872/saglik-tesisleri.html. Accessed 30 March 2025.
  • World Health Organization. ICD-10 Version: 2010 (International Statistical Classification of Diseases and Related Health Problems 10th Revision). Internet. Available at: https://icd.who.int/browse10/2010/en. Accessed 30 March 2025.
  • Ministry of Health, Directorate of Health Quality and Accreditation. SKS Gösterge Yönetimi Rehberi (Indicator Management Guide). (Original release 2015; updated online). Internet. Available at: https://shgmkalitedb.saglik.gov.tr/Eklenti/45623/0/sks-gosterge-yonetimi-rehberi-rev02325042023pdf.pdf Accessed 30 March 2025.
  • Wiler JL, Welch S, Pines J, Schuur J, Jouriles N, Stone-Griffith S. Emergency department performance measures updates: proceedings of the 2014 emergency department benchmarking alliance consensus summit. Acad Emerg Med. 2015 May;22(5):542-53. doi: 10.1111/acem.12654.
  • Noel G, Drigues C, Viudes G; Fedoru Crowding Working Group. Which indicators to include in a crowding scale in an emergency department? A national French Delphi study. Eur J Emerg Med. 2018 Aug;25(4):257-263. doi: 10.1097/MEJ.0000000000000454.
  • Klingner J, Moscovice I. Development and testing of emergency department patient transfer communication measures. J Rural Health. 2012 Jan;28(1):44-53. doi: 10.1111/j.1748-0361.2011.00374.x.
  • Hernandez-Boussard T, Davies S, McDonald K, Wang NE. Interhospital Facility Transfers in the United States: A Nationwide Outcomes Study. J Patient Saf. 2017 Dec;13(4):187-191. doi: 10.1097/PTS.0000000000000148.
  • Gillman L, Jacobs I, Fatovich DM. Challenges in arranging interhospital transfer from a non-tertiary hospital emergency department in the Perth metropolitan area. Emerg Med Australas. 2014 Dec;26(6):567-72. doi: 10.1111/1742-6723.12299.
  • Gulacti U, Lok U, Celik M, Aktas N, Polat H. The ED use and non-urgent visits of elderly patients. Turk J Emerg Med. 2016 Oct 14;16(4):141-145. doi: 10.1016/j.tjem.2016.08.004.
  • Chowdhury SR, Chandra Das D, Sunna TC, Beyene J, Hossain A. Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis. EClinicalMedicine. 2023 Feb 16;57:101860. doi: 10.1016/j.eclinm.2023.101860.
  • Guler S, Aksel G, Ayilgan FT, Ilke Ozkan H, Baz U, 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. 2014;13(2):62-66. doi:10.5152/jaem.2014.24008.

An Analysis of External Referrals from an Emergency Room

Yıl 2025, Cilt: 8 Sayı: 3, 128 - 133, 30.09.2025
https://doi.org/10.54996/anatolianjem.1496484

Öz

Aim: This study aimed to determine the characteristics and outcomes of patients who were referred from a university hospital emergency room (ER) to other facilities.
Material and Methods: This study investigates the characteristics and outcomes of adult patients who were admitted to Hospital Emergency Room (HER) from January 1, 2011 to December 31, 2012 and were referred to another facility for a variety of reasons.
Results: Of the 164,810 patients who visited HER in these two years, 429 (0.26%) who met the inclusion criteria were included in the study. The most common reason for referrals was the lack of available intensive care unit beds (51%). The most common medical problem was respiratory system disease (49%). The patients’ mean length of stay in HER before referral was 39 hours (1-360 hours). Most of the referrals were done by ambulance (n=368, 86%). No cardiopulmonary arrests occurred during the transfers, and no cardiopulmonary resuscitation (CPR) was performed. Of the patients, 26% died in the facilities to which they were referred. Only 2.6% of these deaths occurred in the first 24 hours after the transfer.
Conclusion: This study found that the rate of referrals from the level-3 emergency room was low, that the most common medical reason for referrals was respiratory diseases, and that the most common reason for referrals was the lack of available intensive care beds. Most of the deaths of patients in the facilities to which they were referred occurred more than 24 hours after their transfers.

Etik Beyan

The authors declare no conflict of interest.

Destekleyen Kurum

None

Teşekkür

None

Kaynakça

  • Liu L, Liu C, Duan Z, Pan J, Yang M. Factors associated with the inter-facility transfer of inpatients in Sichuan province, China. BMC Health Serv Res. 2019;19(1):1-11. doi:10.1186/s12913-019-4153-7.
  • Gray A, Gill S, Airey M, Williams R. Descriptive epidemiology of adult critical care transfers from the emergency department. Emerg Med J. 2003;20(3):242-246. doi:10.1136/emj.20.3.242.
  • Appropriate Interfacility Patient Transfer. Ann of Emerg Med. 2016;67(5):690-690. doi: 10.1016/j.annemergmed.2016.03.013.
  • Stolte E, Iwanow R, Hall C. Capacity-related interfacility patient transports: patients affected, wait times involved and associated morbidity. CJEM. Jul 2006;8(4):262-8. doi:10.1017/s1481803500013816.
  • Melkun ET, Ford C, Brundage SI, Spain DA, Chang J. Demographic and Financial Analysis of EMTALA Hand Patient Transfers. Hand (New York, NY). 2010/3// 2010;5(1):72-6. doi:10.1007/s11552-009-9214-7.
  • Nacht J, MacHt M, Ginde AA. Interhospital Transfers from U.S. Emergency Departments: Implications for Resource Utilization, Patient Safety, and Regionalization. Acad Emerg Med. 2013/9// 2013;20(9):888-893. doi:10.1111/acem.12209.
  • Sampalis JS, Denis R, Lavoie A, et al. Trauma care regionalization: a process-outcome evaluation. J Trauma. 1999 Apr;46(4):565-79; discussion 579-81. doi: 10.1097/00005373-199904000-00004.
  • Kindermann DR, Mutter RL, Cartright-Smith L, Rosenbaum S, Pines JM. Admit or transfer? the role of insurance in high-transfer-rate medical conditions in the emergency department. Ann of Emerg Med. 2014;63(5):561-571.e8. doi: 10.1016/j.annemergmed.2013.11.019.
  • Roche-Nagle G, Bachynski K, Nathens AB, Angoulvant D, Rubin BB. Regionalization of services improves access to emergency vascular surgical care. Vascular. 2013/4// 2013;21(2):69-74. doi:10.1177/1708538113478726.
  • Eckstein M, Schlesinger SA, Sanko S. Interfacility Transports Utilizing the 9-1-1 Emergency Medical Services System. Prehosp Emerg Care. 2015/10// 2015;19(4):490-495. doi:10.3109/10903127.2015.1005258.
  • Gupta K, Mueller SK. Interhospital transfers: The need for standards. J Hosp Med. 2015 Jun;10(6):415-7. doi: 10.1002/jhm.2320. Epub 2015 Jan 28.
  • Mueller SK, Shannon E, Dalal A, Schnipper JL, Dykes P. Patient and Physician Experience with Interhospital Transfer: A Qualitative Study. J Patient Saf. 2021 Dec 1;17(8):e752-e757. doi: 10.1097/PTS.0000000000000501.
  • Golestanian E, Scruggs JE, Gangnon RE, Mak RP, Wood KE. Effect of interhospital transfer on resource utilization and outcomes at a tertiary care referral center. Crit Care Med. 2007 Jun;35(6):1470-6. doi: 10.1097/01.CCM.0000265741.16192.D9.
  • Nirula R, Maier R, Moore E, Sperry J, Gentilello L. Scoop and run to the trauma center or stay and play at the local hospital: hospital transfer's effect on mortality. J Trauma. 2010 Sep;69(3):595-9; discussion 599-601. doi: 10.1097/TA.0b013e3181ee6e32
  • Naval NS, Chang T, Caserta F, Kowalski RG, Carhuapoma JR, Tamargo RJ. Impact of pattern of admission on outcomes after aneurysmal subarachnoid hemorrhage. J Crit Care. 2012 Oct;27(5):532.e1-7. doi: 10.1016/j.jcrc.2012.03.006.
  • Republic of Turkey Ministry of Health, General Directorate of Health Services. Circular on the Classification of Healthcare Providers (General Letter No. 2019/10). Internet. Available at: https://khgm.saglik.gov.tr/TR-102784/saglik-hizmeti-sunucularinin-basamaklandirilmasi-hakkinda-genelge--201910.html. Accessed 30 September 2025.
  • General Directorate of Public Hospitals. Public Hospitals Statistics Report 2017. Internet. Available at: https://dosyamerkez.saglik.gov.tr/Eklenti/21853/0/kamu-hastaneleri-istatistik-raporu--2017pdf.pdf. Accessed 30 March 2025.
  • Republic of Turkey Official Gazette. Yataklı Sağlık Tesislerinde Acil Servis Hizmetlerinin Uygulama Usul ve Esasları Hakkında Tebliğ. (Published 16 October 2009; Issue No. 27378). Internet. Available at: https://www.istanbulsaglik.gov.tr/w/sb/ash/belge/saglik_bakanligi.pdf. Accessed 30 March 2025.
  • Republic of Turkey Official Gazette. Yataklı Sağlık Tesislerinde Acil Servis Hizmetlerinin Uygulama Usul ve Esasları Hakkında Tebliğ — Amendment. (Published 13 September 2022; Issue No. 31952; with further amendments 11 October 2024; Issue No. 32689). Internet. Available at: https://www.resmigazete.gov.tr/eskiler/2023/05/20230513-8.htm. Accessed 30 March 2025.
  • Ertan C, Akgün FS, Yücel N. Bir Üniversite Hastanesi Acil Servisine Yapılan Sevklerin İncelenmesi. Turk J Emerg Med. 2010;10(January):65-70.
  • Atilla Duman Ö, Oray D, Akin Ş, Acar K, Bi̇lge A. An Emergency Department perspective: Ambulance transfers and referral consents of the patients. Turk J Emerg Med. 2010;10(4):175-180.
  • Republic of Turkey Ministry of Health, İzmir Provincial Directorate of Health. Healthcare Facilities (Sağlık Tesisleri). Internet. Available at: https://izmirism.saglik.gov.tr/TR-134872/saglik-tesisleri.html. Accessed 30 March 2025.
  • World Health Organization. ICD-10 Version: 2010 (International Statistical Classification of Diseases and Related Health Problems 10th Revision). Internet. Available at: https://icd.who.int/browse10/2010/en. Accessed 30 March 2025.
  • Ministry of Health, Directorate of Health Quality and Accreditation. SKS Gösterge Yönetimi Rehberi (Indicator Management Guide). (Original release 2015; updated online). Internet. Available at: https://shgmkalitedb.saglik.gov.tr/Eklenti/45623/0/sks-gosterge-yonetimi-rehberi-rev02325042023pdf.pdf Accessed 30 March 2025.
  • Wiler JL, Welch S, Pines J, Schuur J, Jouriles N, Stone-Griffith S. Emergency department performance measures updates: proceedings of the 2014 emergency department benchmarking alliance consensus summit. Acad Emerg Med. 2015 May;22(5):542-53. doi: 10.1111/acem.12654.
  • Noel G, Drigues C, Viudes G; Fedoru Crowding Working Group. Which indicators to include in a crowding scale in an emergency department? A national French Delphi study. Eur J Emerg Med. 2018 Aug;25(4):257-263. doi: 10.1097/MEJ.0000000000000454.
  • Klingner J, Moscovice I. Development and testing of emergency department patient transfer communication measures. J Rural Health. 2012 Jan;28(1):44-53. doi: 10.1111/j.1748-0361.2011.00374.x.
  • Hernandez-Boussard T, Davies S, McDonald K, Wang NE. Interhospital Facility Transfers in the United States: A Nationwide Outcomes Study. J Patient Saf. 2017 Dec;13(4):187-191. doi: 10.1097/PTS.0000000000000148.
  • Gillman L, Jacobs I, Fatovich DM. Challenges in arranging interhospital transfer from a non-tertiary hospital emergency department in the Perth metropolitan area. Emerg Med Australas. 2014 Dec;26(6):567-72. doi: 10.1111/1742-6723.12299.
  • Gulacti U, Lok U, Celik M, Aktas N, Polat H. The ED use and non-urgent visits of elderly patients. Turk J Emerg Med. 2016 Oct 14;16(4):141-145. doi: 10.1016/j.tjem.2016.08.004.
  • Chowdhury SR, Chandra Das D, Sunna TC, Beyene J, Hossain A. Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis. EClinicalMedicine. 2023 Feb 16;57:101860. doi: 10.1016/j.eclinm.2023.101860.
  • Guler S, Aksel G, Ayilgan FT, Ilke Ozkan H, Baz U, 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. 2014;13(2):62-66. doi:10.5152/jaem.2014.24008.
Toplam 32 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Acil Tıp
Bölüm Orijinal Çalışma
Yazarlar

Nurcan Bicakci 0000-0003-1358-9224

Rıdvan Atilla 0000-0002-2260-6981

Nese Colak 0000-0001-6821-9031

Aslı Acerer Tipici 0000-0002-0216-2789

Yayımlanma Tarihi 30 Eylül 2025
Gönderilme Tarihi 1 Temmuz 2024
Kabul Tarihi 11 Haziran 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 8 Sayı: 3

Kaynak Göster

AMA Bicakci N, Atilla R, Colak N, Acerer Tipici A. An Analysis of External Referrals from an Emergency Room. Anatolian J Emerg Med. Eylül 2025;8(3):128-133. doi:10.54996/anatolianjem.1496484