Hastaneler arası hasta sevklerinin akademik bir acil servis perspektifinden değerlendirilmesi: retrospektif, gözlemsel bir araştırma
Date
2024-05-06
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Abstract
Araştırmamızın amacı, acil servise sevk ile kabul edilen hastaların sevk nedenleri, konulan tanılar ve klinik ya da yoğun bakım ihtiyaçları üzerinde bir karşılaştırma yaparak sevk gerekliliğinin uygunluğunu değerlendirmektir. Bu değerlendirme, sevk uygunluğunu analiz ederek etkin hasta yönetimi ve yoğunluğun etkili bir şekilde yönetilmesi konusunda stratejiler geliştirmeyi hedeflemektedir. Hastanemiz acil servisinde 01.07.2022-31.07.2023 tarihleri arasında sevk ile kabul edilen 4365 hastaya ait veriler geriye dönük olarak değerlendirildi. Hastaların ilk değerlendirme sonrası belirtilen sevk gereksinimi, tıbbi durumları, hastaların değerlendiren hekim tarafından istenen konsültasyonları, klinik ya da yoğun bakım yatış gereksinimi, acil serviste kalış süresi ve acil servis ve hastane içi mortalite durumu değerlendirildi. Hastaların sevk gereksinimi, hastayı değerlendiren acil tıp uzmanı tarafından talep edilen konsültasyonlar ve hastanın yatış ya da taburculuk durumuna göre karşılaştırılaştırıldı. Sevk sayısının %81,1 oranında en sık ilçe devlet hastanesinden olduğu ve sevk tanıları içinde en fazla iskemik kalp hastalıkları (%4,9) olduğu tespit edildi. Nakil sebepleri içinde en yüksek oranda gözlenen uzman hekim ihtiyacıdır Geliş tanısı (sevk tanısı) ile acil tanısı arasındaki uyumluluk oranı %48,5’ tir. Yan dal konsültasyon oranı ise %17,6 olarak bulundu. Sevk edilen hastaların acil serviste yaklaşık yarısı (%47,7) yoğun bakım ünitesine yatış ile sonlanmıştır. Hastaneler arası nakiller, her bir aşamasında özel bir analiz gerektiren, hastaların etkili ve gerektiği şekilde tedavi almalarını sağlamak için kritik bir öneme sahiptir. Hastanemize yapılan sevk tanıları içinde en fazla iskemik kalp hastalıkları, travma ve intoksiksyonların yer aldığı görüldü. Nakil sebepleri içinde en yüksek oranda gözlenen sebep uzman hekim ihtiyacıdır. Koordineli bir sağlık hizmeti sunumu için perifer hastanelerde uzman hekim ihtiyacının ve hastane kapasitelerinin gözden geçirilmesi belirleyici olabilir.
Our study aimed to assess the appropriateness of referral by comparing the reasons for referral, diagnoses, and clinical or intensive care needs of patients admitted to the emergency department. By analyzing the appropriateness of referral, this evaluation aims to develop strategies for efficient patient management and effective management of overcrowding. The data of 4365 patients admitted with referral between 01.07.2022 and 31.07.2023 in the emergency department of our hospital were evaluated retrospectively. The need for referral, medical conditions, consultations requested by the evaluating physician, need for clinical or intensive care hospitalization, length of stay in the emergency department, and emergency department and in-hospital mortality status were evaluated. The need for referral, consultations requested by the evaluating emergency physician, and hospitalization or discharge status of the patients were compared. The most common referral diagnosis was ischemic heart disease (47.9%), which was 81.1% from the district state hospital. This diagnosis was followed by "trauma intoxication, burn diagnosis," and "cerebrovascular diseases". Among the reasons for transfer, the need for a specialist physician was observed at the highest rate. The concordance rate between the diagnosis of arrival (referral diagnosis) and the emergency diagnosis was 48.5%. The rate of subspecialty consultation was 17.6%. Approximately half (47.7%) of the referred patients in the emergency department ended with hospitalization in the intensive care unit. Inter-hospital transfers are critical to ensure that patients receive effective and appropriate treatment, requiring special analysis at each stage. It was determined that 81.1% of the referrals to our hospital were from district state hospitals and the most common diagnosis of referral was ischemic heart disease (47.9%). This diagnosis was followed by "trauma intoxication, burns" and "cerebrovascular diseases". The most common reason for transfers was the need for specialized physicians. For a coordinated health service delivery, it may be decisive to review the need for specialist physicians and hospital capacities in peripheral hospitals.
Our study aimed to assess the appropriateness of referral by comparing the reasons for referral, diagnoses, and clinical or intensive care needs of patients admitted to the emergency department. By analyzing the appropriateness of referral, this evaluation aims to develop strategies for efficient patient management and effective management of overcrowding. The data of 4365 patients admitted with referral between 01.07.2022 and 31.07.2023 in the emergency department of our hospital were evaluated retrospectively. The need for referral, medical conditions, consultations requested by the evaluating physician, need for clinical or intensive care hospitalization, length of stay in the emergency department, and emergency department and in-hospital mortality status were evaluated. The need for referral, consultations requested by the evaluating emergency physician, and hospitalization or discharge status of the patients were compared. The most common referral diagnosis was ischemic heart disease (47.9%), which was 81.1% from the district state hospital. This diagnosis was followed by "trauma intoxication, burn diagnosis," and "cerebrovascular diseases". Among the reasons for transfer, the need for a specialist physician was observed at the highest rate. The concordance rate between the diagnosis of arrival (referral diagnosis) and the emergency diagnosis was 48.5%. The rate of subspecialty consultation was 17.6%. Approximately half (47.7%) of the referred patients in the emergency department ended with hospitalization in the intensive care unit. Inter-hospital transfers are critical to ensure that patients receive effective and appropriate treatment, requiring special analysis at each stage. It was determined that 81.1% of the referrals to our hospital were from district state hospitals and the most common diagnosis of referral was ischemic heart disease (47.9%). This diagnosis was followed by "trauma intoxication, burns" and "cerebrovascular diseases". The most common reason for transfers was the need for specialized physicians. For a coordinated health service delivery, it may be decisive to review the need for specialist physicians and hospital capacities in peripheral hospitals.
Description
Keywords
Hastaneler arası sevk, Hasta nakil gereksinimi, Acil servis, Inter-hospital referral, Patient transportation requirement, Emergency department
Citation
Dal, E. vd. (2024). "Hastaneler arası hasta sevklerinin akademik bir acil servis perspektifinden değerlendirilmesi: retrospektif, gözlemsel bir araştırma". Uludağ Üniversitesi Tıp Fakültesi Dergisi, 50(1), 77-84.