一种用于描述创伤转运网络中机构间转运策略的新方法。
A novel methodology to characterize interfacility transfer strategies in a trauma transfer network.
作者信息
Gomez David, Haas Barbara, Larsen Kristian, Alali Aziz S, MacDonald Russell D, Singh Jeffrey M, Tien Homer, Iwashyna Theodore J, Rubenfeld Gordon, Nathens Avery B
机构信息
From the Division of General Surgery, Department of Surgery (D.G., H.T., A.B.N.), University of Toronto, Ontario, Canada; Sunnybrook Research Institute (D.G., B.H., A.A., H.T., G.R., A.B.N.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care (B.H., A.S.A., J.M.S., J.R.), University of Toronto, Ontario, Canada; Child Health Evaluative Sciences (K.L.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Geography and Planning (K.L), University of Toronto, Ontario, Canada; Ornge Transport Medicine (R.D.M., H.T.), Mississauga, Ontario, Canada; Division of Emergency Medicine, Department of Medicine (R.D.M.), University of Toronto, Ontario, Canada; Toronto Western Research Institute (J.M.S.), Toronto Western Hospital, Toronto, Ontario, Canada; and Department of Internal Medicine (T.J.I.), University of Michigan Medical School, Ann Arbor, Michigan.
出版信息
J Trauma Acute Care Surg. 2016 Oct;81(4):658-65. doi: 10.1097/TA.0000000000001187.
BACKGROUND
More than half of severely injured patients are initially transported from the scene of injury to nontrauma centers (NTCs), with many requiring subsequent transfer to trauma center (TC) care. Definitive care in the setting of severe injury is time sensitive. However, transferring severely injured patients from an NTC is a complex process often fraught with delays. Selection of the receiving TC and the mode of interfacility transport both strongly influence total transfer time and are highly amenable to quality improvement initiatives.
METHODS
We analyzed transfer strategies, defined as the pairing of a destination and mode of transport (land vs. rotary wing vs. fixed wing), for severely injured adult patients. Existing transfer strategies at each NTC were derived from trauma registry data. Geographic Information Systems network analysis was used to identify the strategy that minimized transfer times the most as well as alternate strategies (+15 or +30 minutes) for each NTC. Transfer network efficiency was characterized based on optimality and stability.
RESULTS
We identified 7,702 severely injured adult patients transferred from 146 NTCs to 9 TCs. Nontrauma centers transferred severely injured patients to a median of 3 (interquartile range, 1-4) different TCs and utilized a median of 4 (interquartile range, 2-6) different transfer strategies. After allowing for the use of alternate transfer strategies, 73.1% of severely injured patients were transported using optimal/alternate strategies, and only 40.4% of NTCs transferred more than 90% of patients using an optimal/alternate transfer strategy. Three quarters (75.5%) of transfers occurred between NTCs and their most common receiving TC.
CONCLUSION
More than a quarter of patients with severe traumatic injuries undergoing interfacility transport to a TC in Ontario are consistently transported using a nonoptimal combination of destination and mode of transport. Our novel analytic approach can be easily adapted to different system configurations and provides actionable data that can be provided to NTCs and other stakeholders.
LEVEL OF EVIDENCE
Therapeutic study, level IV.
背景
超过半数的重伤患者最初是从受伤现场转运至非创伤中心（NTC），其中许多患者随后需要转至创伤中心（TC）接受治疗。重伤情况下的确定性治疗对时间要求严格。然而，将重伤患者从非创伤中心转出是一个复杂的过程，常常伴有延误。接收创伤中心的选择以及机构间转运方式均对总转运时间有重大影响，并且极适合开展质量改进举措。
方法
我们分析了重伤成年患者的转运策略，即目的地与转运方式（陆路、旋翼机或固定翼飞机）的配对。每个非创伤中心现有的转运策略源自创伤登记数据。利用地理信息系统网络分析来确定使转运时间最短的策略以及每个非创伤中心的替代策略（增加15或30分钟）。基于最优性和稳定性对转运网络效率进行了表征。
结果
我们确定了7702例从146个非创伤中心转至9个创伤中心的重伤成年患者。非创伤中心将重伤患者转至中位数为3个（四分位间距，1 - 4个）不同的创伤中心，并使用中位数为4种（四分位间距，2 - 6种）不同的转运策略。在允许使用替代转运策略后，73.1%的重伤患者采用了最优/替代策略进行转运，只有40.4%的非创伤中心使用最优/替代转运策略转运了超过90%的患者。四分之三（75.5%）的转运发生在非创伤中心与其最常见的接收创伤中心之间。
结论
在安大略省，超过四分之一的严重创伤患者在机构间转运至创伤中心时，始终采用目的地和转运方式的非最优组合。我们新颖的分析方法可轻松适用于不同的系统配置，并提供可操作的数据，这些数据可提供给非创伤中心和其他利益相关者。
证据水平
治疗性研究，IV级。
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