INTERHOSPITAL TRANSFER IN THE MANAGEMENT OF ACUTE TRAUMA
INTERHOSPITAL TRANSFER IN THE MANAGEMENT OF ACUTE TRAUMA
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DOI：
10.1111/j.1445-2197.1990.tb07399.x
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发表时间：
1990-06-01
期刊：
影响因子：
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通讯作者：
MCNEIL, RJ
中科院分区：
文献类型：
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作者：
DEANE, SA;GAUDRY, PL;MCNEIL, RJ
在8个月的时间里，538名受伤的病人从基层医院转移到转诊医院接受进一步的治疗。20%的转院患者和40%的因头部损伤或多系统损伤而转院的患者在初级医院发生延误。在一级医院的延迟导致从受伤到到达二级医院的中位时间为4小时。运输过程中临床管理的缺陷包括护送人员经验不足、气道控制、通气、液体复苏和胸部损伤的稳定不足。近一半的转会是不合适的，因为伤势相对较轻。其中大多数人有孤立的四肢肌肉骨骼损伤。这些患者反映了研究期间西悉尼骨科专科服务的明显不足。在西悉尼发展一个大都市区域创伤护理系统需要采取紧急行动，减少转移的频率，尽量减少转移的延误，并最大限度地提高重伤患者的基本复苏。一些指定的医院角色是必要的，并需要伴随着一个院前分流过程。居民也有权期望在郊区医院获得适当的专科服务，以便能够治疗轻微和中度的单一系统损伤。未来创伤系统的发展应充分反映人口增长和临床护理技术的进步。
During an 8-month period, 538 injured patients were transferred from primary hospitals to a referral hospital for further management of their injuires. Delay at the primary hospital was identified in 20% of all transfers and in 40% of patients transferred for management of head injury or multisystem injury. Delay at the primary hospital resulted in a median time from injury to arrival at the second hospital of 4 h. Defects in clinical management during transport included inexperienced escorts, inadequate airway control, ventilation, fluid resuscitation and stabilization of chest injuries. Nearly half of transfers were inappropriate because of the relatively minor nature of the injuries. Most of these had solitary musculoskeletal injuries to the extremities. These patients reflect the marked deficiency of specialist orthopaedic services in western Sydney during the study. Development of a metropolitan regional system of trauma care in western Sydney requires urgent action towards reducing the frequency of transfer, minimizing delays in transfer and maximizing basic resuscitation of seriously injured patients. Some designation of hospital roles is required and needs to be accompanied by a prehospital triage process. The population also has a right to expect adequate specialty services at suburban hospitals to enable treatment of minor and moderate single system injuries. Future trauma system developments should adequately reflect population growth and technological advances in clinical care.