Defining obstacles to emergency transfer of trauma patients: An evaluation of retriage processes from nontrauma and lower-level Illinois trauma centers.
Defining obstacles to emergency transfer of trauma patients: An evaluation of retriage processes from nontrauma and lower-level Illinois trauma centers.
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DOI：
10.1016/j.surg.2022.08.027
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发表时间：
2022-12
期刊：
影响因子：
3.8
通讯作者：
Stey, Anne M.
中科院分区：
文献类型：
--
作者：
Slocum, John D.;Holl, Jane L.;Love, Remi;Shi, Meilynn;Mackersie, Robert;Alam, Hasan;Loftus, Timothy M.;Andersen, Rebecca;Bilimoria, Karl Y.;Stey, Anne M.
再分诊是指将严重受伤的患者从非创伤和较低级别的创伤中心紧急转移到较高级别的创伤中心。我们确定了在单一卫生系统中的派遣中心进行再分诊的障碍。我们在单一卫生系统的 4 个非创伤中心和 5 个较低级别的创伤中心进行了故障模式影响和严重性分析。每个中心的临床医生描述了创伤评估和重检过程的步骤，以创建流程图。我们使用标准化评分来根据频率、对重检的影响和预防措施来描述每次失败的特征。我们使用分数对每个失败进行排名，以计算风险优先级数字。我们确定了 26 个步骤和 93 个失败之处。风险最高的失败是上级创伤中心（接收医院）拒绝接收患者。根据总风险、频率和保障评分，重检流程中最严重的失败是（1）接收更高级别创伤中心拒绝接收患者（风险优先级编号 = 191），（2）发送中心延迟对急诊科患者进行顾问检查（风险优先级编号 = 177），以及（3）延迟接收医院顾问回电（风险优先级编号 = 177）。我们确定了 (1) 解决确定重检临床指征的障碍，以及 (2) 确定接收一级创伤中心，这些中心将接受患者作为增加及时重检的机会。建立发送和接收医院都同意的明确的再分诊临床指征是一个可以改善受伤患者再分诊的干预机会。
Retriage is the emergency transfer of severely injured patients from nontrauma and lower-level trauma centers to higher-level trauma centers. We identified the barriers to retriage at sending centers in a single health system. We conducted a failure modes effects and criticality analysis at 4 nontrauma centers and 5 lower-level trauma centers in a single health system. Clinicians from each center described the steps in the trauma assessment and retriage process to create a process map. We used standardized scoring to characterize each failure based on frequency, impact on retriage, and prevention safeguards. We ranked each failure using the scores to calculate a risk priority number. We identified 26 steps and 93 failures. The highest-risk failure was refusal by higher-level trauma centers (receiving hospitals) to accept a patient. The most critical failures in the retriage process based on total risk, frequency, and safeguard scores were (1) refusal from a receiving higher-level trauma center to accept a patient (risk priority number = 191), (2) delay in a sending center's consultant examination of a patient in the emergency department (risk priority number = 177), and (3) delay in receiving hospital's consultant calling back (risk priority number = 177). We identified (1) addressing obstacles to determining clinical indications for retriage and (2) identifying receiving level I trauma centers who would accept the patient as opportunities to increase timely retriage. Establishing clear clinical indications for retriage that sending and receiving hospitals agree on represents an opportunity for intervention that could improve the retriage of injured patients.
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DOI：
10.1108/ijqrm-04-2013-0068
发表时间：
2014-01-01
影响因子：
2.5
作者：
Das Adhikary, Debasis;Bose, Goutam;Mitra, Souren
通讯作者：
Mitra, Souren
DOI：
10.1111/j.1445-2197.1990.tb07399.x
发表时间：
1990-06-01
期刊：
AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY
影响因子：
--
作者：
DEANE, SA;GAUDRY, PL;MCNEIL, RJ
通讯作者：
MCNEIL, RJ
DOI：
10.1097/ta.0b013e31803c5665
发表时间：
2007-11-01
影响因子：
--
作者：
Newgard, Craig D.;McConnell, K. John;Mullins, Richard J.
通讯作者：
Mullins, Richard J.
影响因子：
5.4
作者：
McElroy, Lisa M.;Khorzad, Rebeca;Holl, Jane L.
通讯作者：
Holl, Jane L.
影响因子：
6.2
作者：
Khare, Rahul K.;Nannicelli, Anna P.;Holl, Jane L.
通讯作者：
Holl, Jane L.