Bir Çocuk Acil Servis Deneyimi: Ambulans Kullanım Nedenleri

Öz

Amaç: Hastaneler arası hasta sevkleri, hastaların ileri tıbbi bakım ve tedaviye ihtiyaç duydukları ve sevk eden hastanedeki personel, ekipman ve tıbbi-teknik imkânların ihtiyaçları karşılamakta yetersiz kaldığı durumlarda yapılmaktadır. Bu çalışmanın amacı, çocuk acil servisine 112 acil sağlık hizmetleri aracılığıyla sevk edilen ve yine bu birimden başka sağlık kuruluşlarına sevki gerçekleştirilen hastaların demografik, klinik ve sevk sürecine ilişkin özelliklerini kapsamlı şekilde değerlendirmektir. Yöntem: Bu çalışmada, Ocak 2023 ile Aralık 2023 tarihleri arasında Samsun Eğitim ve Araştırma Hastanesi Çocuk Acil Servisine başvuran ve farklı merkezlere sevk edilen hastaların demografik özellikleri, başvuru zamanı, klinik şikayetleri, yatış yapılan servisler, sevk edildikleri sağlık kurumları ve sevk nedenleri retrospektif olarak incelendi. Bulgular: Toplam 873 hasta (626 gelen, 247 giden) çalışmaya dahil edildi. Hastaların yaş ortalaması 86,93±63,31 aydı. Gelen hastaların %79,7’si (n=499) önceden bildirim yapılmadan gönderilmişti. En sık sevklerin cuma günü, ilkbahar mevsiminde ve 16.00–24.00 saatleri arasındaki vardiyada gerçekleştiği saptandı. En yaygın başvuru nedenleri karın ağrısı (%26,7; n=167), nöbet (%11,9; n=75) ve solunum sıkıntısı (%8,9; n=56) idi. Gelen hastaların %56,7’si (n=355) hastaneye yatırıldı. Sevk edilen hastalarda en sık görülen tanılar nöbet bozuklukları (%23,8; n=59), travmatik yaralanmalar (%8,9; n=22) ve onkolojik hastalıklar oldu. Sonuç: Sevk zinciri, acil pediatrik hasta yönetiminin önemli bir bileşenidir. Sevk süreçlerinde yaşanan iletişim eksiklikleri ve kaynak yetersizlikleri, hasta bakım kalitesini doğrudan etkileyebilmektedir. Bu nedenle, sevk kriterlerinin standardize edilmesi, sağlık personeline yönelik hizmet içi eğitimlerin artırılması ve sistematik sağlık politikalarının geliştirilmesi gerekmektedir.

Anahtar Kelimeler

• ambulans
• Çocuk Acil
• ön bildirim
• sevk

A Pediatric Emergency Department Experience: Causes of Ambulance Use

Öz

Objective: Interhospital patient referrals occur when patients require advanced medical care and treatment and the staff, equipment, and medico-technical facilities at the referring hospital are insufficient to meet these needs. The aim of this study is to comprehensively evaluate the demographic, clinical and referral process characteristics of patients referred to the pediatric emergency department via 112 emergency health services and referred to other health institutions from this unit. Method: The demographic characteristics, time of admission, clinical complaints, inpatient services, referral centers, and reasons for referral were retrospectively analyzed in patients admitted to and referred from the pediatric emergency department of Samsun Training and Research Hospital between January 2023 and December 2023. Results: A total of 873 patients (626 incoming and 247 outgoing) were included in the study. The mean age of the patients was 86.93±63.31 months. Most of the incoming patients (79.7%, n=499) were transferred without prior notification. The most common day of admission was Friday, the most common season was spring, and the most common shift was 16-24 hours. The majority of patients were referred for abdominal pain (26.7%, n=167), seizures (11.9%, n=75), and respiratory distress (8.9%, n=56). Of the presenting patients, 56.7% (355/626) were admitted to the hospital. The most common diagnoses among the transferred patients were seizure disorders (23.8%, n=59), traumatic injuries (8.9%, n=22), and oncologic conditions. Conclusion: The referral chain plays a pivotal critical role in the management of pediatric emergencies. Deficiencies in communication and resources availability during the referral process may adversely affect impact the quality of patient care. Therefore, it is essential to standardize referral criteria, enhance in-service training for healthcare professionals, and implement structured health policies to ensure effective patient transfer and continuity of care.

Anahtar Kelimeler

• ambulance
• Child Emergency
• prior notification
• referral

Kaynakça

1. 1. Frush K; American Academy of Pediatrics Committee on Pediatric Emergency Medicine. Preparation for emergencies in the offices of pediatricians and pediatric primary care providers. Pediatrics. 2007; 120(1):200– 212.
2. 2. Petruzella F, Easter JS. Pediatric emergency medicine literature 2020. Am J Emerg Med. 2021; 43:123-33.
3. 3. A statement on the implementation procedures and principles of emergency services in inpatient healthcare facilities. The document was published in the Official Gazette (No. 31952) on September 13, 2022.
4. 4. Kıdak L, Keskinoğlu P, Sofuoğlu T, Ölmezoğlu Z. Evaluation of the utilization of 112 Emergency Ambulance services in Izmir Province. J Gen Med. 2009; 19(3): 113- 119.
5. 5. Zenginol, M., Al, B., Genc, S., Deveci, I., Yarbil, P., Ari Yilmaz, D., et al. Three-Year Operation Results of 112 Emergency Ambulances in Gaziantep Province. J Acad Emerg Med. 2011; 10(1), 27-32.
6. 6. Önge, T., Satar, S., Kozaci, N., Acikalin, A., Koseoglu, Z., Gulen, M., Karakurt, U. Analysis of Adult Patients Brought to Emergency Medicine Service with 112. J Acad Emerg Med 2013;12(3), 150-154.
7. 7. Kozan, Ergül. 2017. General Characteristics, Diagnosis and Evaluation of Patients Brought to the Emergency Department by Ambulance. Medical Specialization Thesis: University of Health Sciences, Istanbul.
8. 8. Duran, M. (2015). 112 Kayseri Emergency Health Services 2013 Year Case Analysis. Medicine Specialization Thesis: Erciyes University Faculty of Medicine.

9. 9. Özel G. (2019) Determination of factors affecting pediatric emergency department density. Medicine Specialization Thesis: Adıyaman University Faculty of Medicine.
10. 10. Jacob N, Marlow M. Interhospital Transfers from U.S. Emergency Departments: Implications for Resource Utilization, Paient Safety, and Regionalization. Acad Emerg Med 2013; 20:888-93.
11. 11. Dana RK, Ryan LM, Lara CS. Admit or Transfer? The Role of Insurance in hightransfer-Rate Medical Conditions in the Emergency Department. Ann Emerg Med. 2014;63(5):561-71.
12. 12. GönçerDemiralD,ÖzenÜ.Hastanelerarasıhastasevkleri:doğukaradenizhastaneleriüzerinebiruygulama. J Manag Econ Res. 2020;18(4):190-208.
13. 13. Karakas NM, Ozdemir B, Kilic S, Akbulut O. Reasons for PED Aplications of Parents: 4 Years Follow-Up, Osmangazi J Med. 2020;42(1):67-74.
14. 14. Yıldız Y, Kanburoğlu MK. Çocuk Acil Servisinde Sağlık Hizmetleri Sunum Kalitesi ve Hasta Memnuniyeti. J Pediatr Emerg Intensive Care Med. 2021;8(1):7-14.
15. 15. Snooks H, Wrigley H, George S, Thomas E, Smith H, Glasper A. Appropriateness of use of emergency ambulances. J Accid Emerg Med 1998; 15:212-5.
16. 16. Kumandaş S, Canpolat M, editors. Pediatric neurological emergencies: diagnosis and treatment. Ankara: Akademisyen Publishing; 2022.
17. 17. Karakus Yılmaz B, Yılmaz Karakuş B, Çevik E, Dogan H, Sam M, Kutur A. Emergency medical services (EMS) in a metropolitan area: A study from Istanbul. J Ist Faculty Med. 2014; 77(3), 37–40.
18. 18. ErtanC,AkgünF,YücelN.Analysisofreferralstotheemergencydepartmentofauniversityhospital.TurkJ Emerg Med. 2010;10(2):65-70.
19. 19. Çiftçi, H, Topoyan, M. Evaluation of emergency department admissions at Dokuz Eylul University Hospital. In: Proceedings of the 3rd National Congress on Health Institutions Management; Izmir, Turkey. 1:1-22.
20. 20. Erkuran MK, Duran A, Ocak T, Citisli V, Kaya H. The impact of the duration of admission to the emergency room on the mortality of intensive care patients. Niger J Clin Pract. 2014;17(3):320-323.
21. 21. Güler S, Aksel G, Ayılgan FT, Özkan HI, Baz Ü, Orak Y. Evaluation of Emergency Interhospital Patient Transfers from Province of Mardin to Out-of-Province Hospitals in a Year. J Acad Emerg Med, 2014; 13: 62-6.