定义无用的和可能可以避免的医院间创伤转移
James Stafford May1, Jonathan Alexander McCafferty1, David John Read2
1Department of General Surgical Specialties, The Royal Melbourne Hospital, Level 6 East, 300 Grattan St, Parkville 3050 Victoria, Australia.
Injury
|May 28, 2024
概括
虚无的医院间创伤转移 (IHT) 是罕见的,但几乎一半的转移患者没有接受第三级干预. 实施远程医疗可以减少可避免的IHT和相关成本,同时保持创伤护理的质量.
科学领域:
- 创伤外科 手术 创伤外科
- 紧急医疗 紧急医疗
- 医疗保健管理的管理
背景情况:
- 医院间转移 (IHT) 到主要创伤服务减少了严重受伤患者的可预防死亡.
- 然而,有些转移是徒劳的或可能是可以避免的,造成家庭痛苦,护理延迟和资源紧张.
- 描述这些转移对于优化创伤护理系统至关重要.
研究的目的:
- 根据当前的指导方针,对无用的和可能可以避免的医院间创伤转移 (IHT) 进行描述.
- 确定与这些转移相关的频率和患者人口统计数据.
- 为减少非必要转移和改善资源分配制定战略提供信息.
主要方法:
- 转移到主要创伤服务的成年患者的回顾性队列研究 (2016-2020).
- 定义徒劳的IHTs是死亡或临终关怀转移在72小时内没有干预或ICU入院.
- 定义的潜在可避免的IHTs是没有干预或ICU护理的出院,包括二次过分分离.
主要成果:
- 在2,837个IHT中,有7个 (0.2%) 被归类为徒劳,主要是严重受伤的老年女性 (中位数ISS 16).
- 1,391名患者 (49%) 可能可以避免,其中513人 (18%) 被归类为二次过度选 (平均年龄43岁,中位数ISS 9).
- 70.7%的可能可以避免的IHT被直接送回家,没有第三级干预.
结论:
- 虚无的医院间创伤转移很少发生,但很大一部分转移的患者没有接受三级干预.
- 开发远程医疗等系统可以支持区域外科医生共同管理较低风险的创伤,潜在地减少可避免的IHT.
- 优化IHT可以降低医疗保健成本和资源利用率,同时保持高质量的创伤护理和低死亡率.
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