Hastane İçi Alanlardan Çocuk Acil Servisine Yönlendirilen Hastaların Değerlendirilmesi

Öz

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.

Anahtar Kelimeler

• Çocuk Acil Servis
• Hasta Taşıma Güvenliği
• Hastane İçi Transfer
• Triyaj

Evaluation of Patients Directed from In-Hospital Areas to Pediatric Emergency Department

Öz

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.

Anahtar Kelimeler

• Intra-Hospital Transfer
• Patient Transport Safety
• Pediatrik Emergency Medicine
• Triage

Kaynakça

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