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在响应区域以外的非协议患者运输负担在农村紧急医疗服务系统上的负担
H Hill Stoecklein1,2, Isabel C Shimanski1, Christopher K Ryba1
1Department of Emergency Medicine, University of Utah Health, Salt Lake City, Utah.
Prehospital emergency care
|October 7, 2024
概括
医院前人员对患者目的地的决定会影响资源使用. 服务区外的非协议运输,通常是由于患者偏好或临床医生的判断,显著增加了服务外的时间,可能不会改善患者的结果.
科学领域:
- 紧急医疗 紧急医疗
- 在医院前的护理.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 医院前人员根据协议,临床判断,患者需求和偏好做出关键的运输目的地决定.
- 在指定服务区域以外的非协议运输可能导致资源利用效率低下,并延长单元停机时间.
- 关于临床医生在紧急医疗服务 (EMS) 中选择目的地的具体理由的研究有限.
研究的目的:
- 通过农村EMS系统分析服务区运输中断的原因.
- 通过比较住院率和专家咨询率来评估运输目的地决定的适当性.
- 评估目的地决定对EMS资源可用性和运营效率的影响.
主要方法:
- 从一个单一的农村,基于医院的EMS系统回顾一年的场景运输.
- 数据收集包括调度,患者人口统计,第一印象和运输细节,与急诊室 (ED) 记录相匹配.
- 分析重点是描述运输理由,并比较结果 (入院,专家咨询) 作为决定适当性的代理.
主要成果:
- 在2,223次运输中,281次是区域外运输. 患者偏好 (40%) 和临床医生的判断 (24%) 是主要原因.
- 区域外运输超过了单位中位数停机时间的两倍 (140分钟与62分钟相比).
- 住院和专家咨询率因运输逻辑而有显著差异,协议化的运输显示出更高的比率;临床医生的判断在儿科和非创伤病例中的预测能力较低.
结论:
- 无协议的区域外运输显著增加了EMS单元停机时间.
- 目的地决定的理由,特别是某些人群的患者偏好和临床医生的判断,与患者的结果有可变的相关性.
- 未来的运输指南应该将患者的特征和决策理由与资源管理相结合,特别是在资源有限的环境中.
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