To examine the characteristics of patients transferred from a rural hospital emergency department, to compare them with patients admitted on an emergency basis, and to use this information to help plan physician education.
Descriptive study using records for the period January 1, 1991, to June 30, 1992.
The emergency department at Bonnyville Health Centre, an acute care rural hospital located 240 km northeast of Edmonton, serving a catchment population of approximately 10,000.
One thousand fifty-five patients seen in the emergency department who were either transferred to another centre or admitted to the Bonnyville Health Centre on an emergency basis.
For the transferred group, main diagnosis, category of transfer, and reason for transfer. For the admitted group, main diagnosis, length of stay, type of discharge.
Of the 1055 patients ill enough to be either admitted or transferred, 114 (10.8%) were transferred. Those transferred were predominantly men, the elderly, and people with orthopedic injuries or neurologic diseases. Those admitted presented primarily with internal, respiratory, gynecologic, or pediatric disorders. Reason for transfer was mainly lack of specialized services or equipment at the rural hospital.
Patients transferred out of the emergency department differed from those admitted in diagnoses and sex. Most transfers were considered "mandatory." Results of this analysis supported incorporating a formal rotation in orthopedics and adding 4 weeks to the existing emergency medicine rotation in our family medicine residency program.
Cites: Fam Med. 1991 Jul;23(5):351-31884928
Cites: Fam Pract Res J. 1990 Fall;10(1):19-262382578
The impact of delay in obtaining an intensive care unit (ICU) consult from inpatient wards is unclear. The goal of this study was to examine the effect of time to ICU consult from medical and surgical wards on mortality and length of stay (LOS).
This was a retrospective study of 241 adult medical and surgical inpatients admitted at 2 tertiary care ICUs in Canada between 2007 and 2009. Neither institution has medical emergency teams (METs). Patient demographics, time when the patient would have fulfilled MET calling criteria (MET time), time of ICU consult, and ICU admission were analyzed. The main outcome variables were 30-day mortality and ICU LOS.
Multivariate analysis demonstrated an increase in mortality (odds ratio, 1.8; 95% confidence interval, 1.1-2.9; P = .01) with increased duration from MET time to ICU consult for medical patients. There was no effect of this period on ICU LOS in medical patients. In contrast, in surgical patients, the MET time to ICU consult duration was associated with an increased ICU LOS (coefficient, 2.1 for delay; 95% confidence interval, 0.26-3.8; P = .02) but had no effect on mortality.
Increased duration to ICU consult from MET time is associated with adverse outcomes. These adverse outcomes are different between medical and surgical patients.
Consolidation of neurosurgical (NS) services resulted in emergency medical services guidelines mandating transport of head-injured patients to the NS center if the Glasgow Coma Scale score is 3. This study determined what paramedic, system, or patient factors were associated with secondary head-injury transfer.
This study was a retrospective chart review from January 1996 to November 1998.
Ninety-one patient charts were reviewed. The median transport delay to the NS site was 4 hours 22 minutes. After transfer, 79 (96%) patients were admitted, 25 (30%) underwent craniotomy, and 18 (22%) died. The final diagnosis in 35 (43%) cases was subdural hematoma. Triage guidelines were violated in five patients (6%) and the NS center was on diversion in three (4%) cases. Most delays were related to patient presentations; 17 (21%) patients had no history of head trauma.
Unpredictable patient factors were the most frequent reasons patients required secondary transfer; few protocol violations or system factors were identified. No modifications to the current NS triage criteria are recommended.
Fødestuene utgjør en del av en differensiert og desentralisert fødselsomsorg i Norge. Hensikten med studien var å undersøke forekomst og karakteristika ved planlagte og ikke-planlagte fødestuefødsler og årsaker til overflytting samt resultater for mor og barn.
I perioden 2008-10 ble et tilleggsskjema til rutinemeldingen til Medisinsk fødselsregister fortløpende utfylt av jordmor for 2 514 av i alt 2 556 (98,4 %) fødestuefødsler og for 220 fødsler som var planlagt i fødestue, men der fødselen foregikk andre steder. Data fra tilleggsskjema ble så koblet med rutinedata i Medisinsk fødselsregister og resultater fra fødestuefødsler sammenlignet med resultater fra en lavrisikofødepopulasjon i sykehus.
Av de 2 514 fødestuefødslene var 2 320 (92,3 %) planlagt å foregå der, mens 194 (7,7 %) ikke var det. Ved planlagt fødestuefødsel ble totalt 6,9 % overflyttet til sykehus under fødsel, hvorav 19,5 % blant førstegangsfødende. Det var 0,4 % operative vaginale fødsler ved vanlige fødestuer, 3,5 % ved forsterkede fødestuer og 12,7 % ved fødsler overflyttet fra fødestue til sykehus. Blant barn født i fødestue hadde 0,6 % apgarskår
CommentIn: Tidsskr Nor Laegeforen. 2018 Jun 12;138(10): PMID 29893095
Earlier studies indicate that midwife-led birth settings are associated with modest benefits, including reduced medical interventions and increased maternal satisfaction. The generalizability of these studies to birth settings with low intervention rates, like those generally found in Norway, is not obvious. The aim of the present study was to compare intervention rates associated with labour in low-risk women who begin their labour in a midwife-led unit and a conventional care unit.
Eligible participants were low-risk primiparas who met the criteria for delivery in the midwife-led ward regardless of which cohort they were allocated to. The two wards are localised at the same floor. Women in both cohorts received the same standardized public antenatal care by general medical practitioners and midwifes who were not involved in the delivery. After admission of a woman to the midwife-led ward, the next woman who met the inclusion criteria, but preferred delivery at the conventional delivery ward, was allocated to the conventional delivery ward cohort. Among the 252 women in the midwife-led ward cohort, 74 (29%) women were transferred to the conventional delivery ward during labour.
Emergency caesarean and instrumental delivery rates in women who were admitted to the midwife-led and conventional birth wards were statistically non-different, but more women admitted to the conventional birth ward had episiotomy. More women in the conventional delivery ward received epidural analgesia, pudental nerve block and nitrous oxide, while more women in the midwife-led ward received opiates and non-pharmacological pain relief.
We did not find evidence that starting delivery in the midwife-led setting offers the advantage of lower operative delivery rates. However, epidural analgesia, pudental nerve block and episiotomies were less often while non-pharmacological pain relief was often used in the midwife-led ward.
Cites: Aust N Z J Obstet Gynaecol. 2000 Aug;40(3):268-7411065032
The purpose of the study was to examine the frequency of burdensome care transitions at the end of life, the difference between different types of residential care facilities, and the changes occurring between 2002 and 2008.
A nationwide, register-based retrospective study.
Residential care facilities offering long-term care, including traditional nursing homes, sheltered housing with 24-hour assistance, and long-term care facilities specialized in care for people with dementia.
All people in Finland who died at the age of 70 or older, had dementia, and were in residential care during their last months of life.
Three types of potentially burdensome care transition: (1) any transition to another care facility in the last 3 days of life; (2) a lack of continuity with respect to a residential care facility before and after hospitalization in the last 90 days of life; (3) multiple hospitalizations (more than 2) in the last 90 days of life. The 3 types were studied separately and as a whole.
One-tenth (9.5%) had burdensome care transitions. Multiple hospitalizations in the last 90 days were the most frequent, followed by any transitions in the last 3 days of life. The frequency varied between residents who lived in different baseline care facilities being higher in sheltered housing and long-term specialist care for people with dementia than in traditional nursing homes. During the study years, the number of transitions fluctuated but showed a slight decrease since 2005.
The ongoing change in long-term care from institutional care to housing services causes major challenges to the continuity of end-of-life care. To guarantee good quality during the last days of life for people with dementia, the underlying reasons behind transitions at the end of life should be investigated more thoroughly.
A shortage of intensive care beds and fully-booked intensive care units has a range of undesirable consequences for patients and personnel, eg. transfer to other intensive care units, cancellation of operations, tighter visitation criteria and an increase in the work-load. The problem is illustrated in a national survey.
The survey was undertaken in 3 parts and comprised all 50 adult intensive care units in Denmark. Part 1 was a questionnaire encompassing demographic data, the number of open intensive care beds and how often under or over capacity was experienced in the department. Parts 2 and 3 consisted of a daily registry of the capacity and occupancy rate in the intensive care departments for two weeks along with a contemporary registry of the number of admittances, transfers and cancellations of operations.
In Denmark only 2% of all somatic beds are intensive care beds. Under capacity, defined as a 100% occupancy rate, was experienced weekly or monthly in 80% of all intensive care units in Denmark. Occupancy rate was high, a medium of 78%, highest in level III intensive care units with an 88% occupancy rate. The numbers for transfers were equivalent to 800-1000 patient transfers per year. The number of cancelled operations was equivalent to 2000 per year.
This survey documents that there is a problem with the capacity in Danish intensive care units. Establishing more intensive care beds in selected departments, ensuring personnel for the beds already established and establishing intermediate care beds could relieve the shortage of beds.
Comment In: Ugeskr Laeger. 2007 May 7;169(19):1811; author reply 181117542086
The trend toward operating Canadian hospitals at full capacity necessitates in some settings the transfer of patients from one hospital's emergency department (ED) to another hospital for admission, due to lack of bed availability at the first hospital. Our objectives were to determine how many and which patients are transported, to measure how much time is spent in the peri-transport process and to document any morbidity or mortality associated with these periods of transitional care.
In this retrospective, observational health records review, we obtained health records during February, June and October 2002 for patients evaluated in any 1 of 3 adult EDs from a single Canadian city and subsequently transferred for admission to 1 of the other 2 hospitals. Data included the reason for transport, admitting service, transport process times and administration of key medications (asthma, cardiac, diabetes, analgesic or antibiotics).
Five hundred and thirteen records of transported patients were reviewed, and 507 were evaluated. Of those, 372 (73.4%) transfers were capacity-related and 135 (26.6%) were transferred for specialty services. Of the capacity transports, 219 (58.9%) were admissions for psychiatry and 123 (33.1%) for medicine. Median wait time at the first hospital was 6.7 hours, being longest for psychiatric patients. Thirty patients (8.1%) missed 1 or more doses of a key medication in the peri-transport process, and 8 (2.2%) missed 2 or more.
Overcrowding of hospitals is a significant problem in many Canadian EDs, resulting in measurable increases in lengths of stay. Transfers arranged to other facilities for admission further prolong lengths of stay. Increased boarding times can result in missed medications, which may increase patient morbidity. Further study is needed to assess the need for capacity transfers and the possible risk to patients associated with periods of transitional care.
The time of death is increasingly postponed to a very high age. How this change affects the use of care services at the population level is unknown. This study analyses the care profiles of older people during their last 2?years of life, and investigates how these profiles differ for the study years 1996-1998 and 2011-2013.
Retrospective cross-sectional nationwide data drawn from the Care Register for Health Care, the Care Register for Social Care and the Causes of Death Register. The data included the use of hospital and long-term care services during the last 2?years of life for all those who died in 1998 and in 2013 at the age of =70 years in Finland.
We constructed four care profiles using two criteria: (1) number of days in round-the-clock care (vs at home) in the last 2?years of life and (2) care transitions during the last 6?months of life (ie, end-of-life care transitions).
Between the study periods, the average age at death and the number of diagnoses increased. Most older people (1998: 64.3%, 2013: 59.3%) lived at home until their last months of life (profile 2) after which they moved into hospital or long-term care facilities. This profile became less common and the profiles with a high use of care services became more common (profiles 3 and 4 together in 1998: 25.0%, in 2013: 30.9%). People with dementia, women and the oldest old were over-represented in the latter profiles. In both study periods, fewer than one in ten stayed at home for the whole last 6?months (profile 1).
Postponement of death to a very old age may translate into more severe disability in the last months or years of life. Care systems must be prepared for longer periods of long-term care services needed at the end of life.
The paper analyzes patient contingents at one of the largest tuberculosis hospitals in Russia in 1995 to 1998. Ti has been ascertained that there has been an increase in the number of patients transferred from general hospitals from 9.7 to 27.4%. Patients with caseous pneumonia and intrathoracic lymph node tuberculosis have doubled.