Analysis of Referrals to External Centers from the Emergency Department of a Public Hospital Serving as Secondary Care

Öz

Aim: To analyze the referrals from the emergency department of a state hospital providing secondary health care services to external centers and to provide ideas for studies to reduce referrals. Materials and Methods: This retrospective study was conducted in the emergency department of a hospital providing secondary health care. In the study, referrals from the emergency department to external centers between 01.01.2023-31.12.2023 were analyzed. Results: Within the scope of the study, 375 patients were evaluated. The mean age of the patients was 36.43±25.98 years. According to the age range, the highest number of patient referrals was in the 0-17 age range (34.1%). 70.1% of the patients were male. The most common reason for referral was psychoactive disorder (13.6%). The most common reasons for referral were the absence of a subspecialist (30.4%) and the lack of a specialist in the relevant branch (30.4%). The most common reason for referral was the absence of a pediatric surgery specialist (20%). Considering the institutions to which patients were referred, most referrals were made to city hospitals (48%). Kayseri was the province to which most patients were referred (59.2%). Conclusion: It is thought that the number of referred patients will decrease with the expansion of physically secure ward patient service for psychiatry clinics in secondary care hospitals and increasing the number of subspecialists and physicians especially in branches where the number of specialists is inadequite.

Anahtar Kelimeler

• Emergency Department
• Patient Transfer
• City Hospitals

İkinci basamak olarak hizmet veren bir devlet hastanesinin acil servisinden dış merkezlere yapılan sevklerin analizi

Öz

Amaç: İkinci basamak olarak sağlık hizmeti veren bir devlet hastanesinin acil servisinden dış merkezlere yapılan sevklerin analizini yaparak sevklerin azaltılmasına yönelik yapılacak çalışmalara fikirler sunmaktır. Yöntem: Bu çalışma retrospektif olarak ikinci basamak olarak sağlık hizmeti veren bir hastanede yapıldı. Çalışmada 01.01.2023-31.12.2023 tarihleri arasında acil servisten dış merkezlere yapılan sevkler analiz edildi. Bulgular: Çalışma kapsamında 375 hasta değerlendirildi. Hastaların yaş ortalaması 36,43±25,98 oldu. Yaş aralığına göre bakıldığında en fazla hasta sevki 0-17 yaş aralığındaydı (%34,1). Hastaların %70,1’i erkekti. En fazla psikoaktif bozukluk (%13,6) nedeniyle sevk yapıldığı görüldü. Sevk nedenlerinin en sık yan dal uzmanı yokluğu (%30,4) ve ilgili branş uzmanı yokluğu (%30,4) nedeniyle olduğu görüldü. Branş olarak en çok çocuk cerrahi uzmanı yokluğu nedeniyle (%20) sevk yapıldı. Sevk edilen kurumlara bakıldığında en fazla şehir hastanelerine (%48) sevk yapıldı. En fazla hasta sevk edilen il Kayseri (%59,2) oldu. Sonuç: İkinci basamak hastanelerde psikiyatri kliniği için fiziki olarak kapalı hasta servislerinin yaygınlaştırılması, yan dal uzmanı ve özellikle uzman sayısının az olduğu branşlarda hekim sayısının artırılması ile sevk edilen hasta sayılarında azalma olacağı düşünülmektedir.

Anahtar Kelimeler

• acil servis
• hasta nakli
• hastaneler arası
• şehir hastaneleri

Kaynakça

1. 1. Patel MR, Calhoon JH, Dehmer GJ, Grantham JA, Maddox TM, Maron DJ, et al. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate use criteria for coronary revascularization in patients with stable ischemic heart disease: A report of the american college of cardiology appropriate use criteria task force, american association for thoracic Surgery, American heart association, american society of echocardiography, american society of nuclear cardiology, society for cardiovascular angiography and interventions, society of cardiovascular computed tomography, and society of thoracic surgeons. J Am Coll Cardiol. 2017;69(17):2212- 2241.
2. 2. Collins R, Allard S, Anderson MI, Barasi DS, Cheslyn-Curtis MS, Cobb DC, et al. Standards for unscheduled surgical care (generic). In: Colliins R, editor. Emergency surgery guidance for providers, standards for unscheduled surgical care, commissioners and service planners . London: The Royal College of Surgeons of England , 2011; pp. 18-28.
3. 3. Gradishar WJ, Moran MS, Abraham J, Abramson V, Aft R, Agnese D, et al. Breast cancer, version 3.2024, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2024; 22(5): 331-357.
4. 4. Vincent JL, Creteur J. Ethical aspects of the COVID-19 Crisis: how to deal with an overwhelming shortage of acute beds. european heart journal: Acute Cardiovascular Care, 2019; 8(3): 208-212.
5. 5. Dal E, Eraybar S, Kurtoglu B, Bulut M. Evaluation of patient referrals between hospitals from the perspective of an academic emergency department: A retrospective, observational study. Uludag Medicine J. 2024; 50(1): 77-84.
6. 6. American College of Emergency Physicians. Appropriate interhospital patient transfer. Ann Emerg Med. 2009;54(1):141.
7. 7. Oktay C, Keşaplı M, Akyol C. Status of the process of referrals from neighboring hospitals to Akdeniz University Hospital Emergency Department. Health and Society. 2001; 11; 34-43.
8. 8. Armağan E, Akköse S, Cebişci H, Engindeniz Z, Tokyay R. Do emergency departments comply with the rules of patient transportation? Ulus Trauma J. 2001; 7(1): 13-16.

9. 9. Kringos D, Barbazza E. Health workforce governance: processes, tools and actors towards a competent workforce for integrated health services delivery. Health Policy 2016; 120 (12): 1276-1284.
10. 10. Dedeilia A, Sotiropoulos MG, Hanrahan JG, Janga D. Medical and surgical education challenges and innovations in the COVID-19 Era: a systematic review. In Vivo, 2020; 34(3): 1603-1611.
11. 11. Stroetmann VN, Kubitschke L, Robinson S, Stroetmann KA, Cullen K, McDaid D, et al. How can telehealth help in the provision of integrated care?. Copenhagen: European Commission. 2011.
12. 12. Goncer Demi̇ ral D, Ozen U. Patient referrals between hospitals: an application on eastern black sea hospitals. Journal of Management and Economics Research. 2020;18(4):190-208.
13. 13. Kılıc M, Dokur M, Ulutasdemir N. Problems in emergency patient referrals: An evaluation at the level of a small city. Summit Medical Journal. 2016; 1(1): 17-21.
14. 14. Kaya M. Working Conditions, Workforce and workload of pediatric surgeons in Türkiye. Turkish Journal of Pediatric Surgery. 2023; 37 (3):84-92.
15. 15. Yagcı I, Tasdelen Y, Kıvrak Y. Evaluation of psychiatry consultations requested from a state hospital emergency department. Acibadem University Journal of Health Sciences 2019; 4: 652-656.
16. 16. Studdert DM, Mello MM, Sage WM, DesRoches CM, Peugh J, Zapert K, et al. Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. JAMA. 2005;293(21):2609-2617.
17. 17. Chimerine L, Eisenbrey R [Internet]. The frivolous case for tort law change: Opponents of the legal system exaggerate its costs, ignore its benefits (Economic Policy Institute Briefing Paper) [cited 2025Feb23]. Available from: https://www.epi.org/ publication/bp157/
18. 18. Ceylan Y. Public private partnership in the Turkish health sector and city hospitals. Master’s thesis. Samsun, Ondokuz Mayıs University Institute of Postgraduate Education, 2020.
19. 19. Kayaduvar M. Health labor transformation in city hospitals. PhD Thesis. İzmir, Dokuz Eylül University Institute of Social Sciences, 2021.