Tanaka Kumiko, Nakada Taka-Aki, Fukuma Hiroshi, Nakao Shota, Masunaga Naohisa, Tomita Keisuke, Matsumura Yosuke, Mizushima Yasuaki, Matsuoka Tetsuya
Senshu Trauma and Critical Care Center, 2-23 Rinku Orai Kita, Osaka, 598-8577, Japan.
Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan.
Scand J Trauma Resusc Emerg Med. 2017 Jan 23;25(1):6. doi: 10.1186/s13049-017-0347-3.
A sudden shortage of physician resources due to overwhelming patient needs can affect the quality of care in the emergency department (ED). Developing effective response strategies remains a challenging research area. We created a novel system using information and communication technology (ICT) to respond to a sudden shortage, and tested the system to determine whether it would compensate for a shortage.
Patients (n = 4890) transferred to a level I trauma center in Japan during 2012-2015 were studied. We assessed whether the system secured the necessary physicians without using other means such as phone or pager, and calculated fulfillment rate by the system as a primary outcome variable. We tested for the difference in probability of multiple casualties among total casualties transferred to the ED as an indicator of ability to respond to excessive patient needs, in a secondary analysis before and after system introduction.
The system was activated 24 times (stand-by request [n = 12], attendance request [n = 12]) in 24 months, and secured the necessary physicians without using other means; fulfillment rate was 100%. There was no significant difference in the probability of multiple casualties during daytime weekdays hours before and after system introduction, while the probability of multiple casualties during night or weekend hours after system introduction significantly increased compared to before system introduction (4.8% vs. 12.9%, P < 0.0001). On the whole, the probability of multiple casualties increased more than 2 times after system introduction 6.2% vs. 13.6%, P < 0.0001).
After introducing the system, probability of multiple casualties increased. Thus the system may contribute to improvement in the ability to respond to sudden excessive patient needs in multiple causalities.
A novel system using ICT successfully secured immediate responses from needed physicians outside the hospital without increasing user workload, and increased the ability to respond to excessive patient needs. The system appears to be able to compensate for a shortage of physician in the ED due to excessive patient transfers, particularly during off-hours.
由于患者需求过多导致医生资源突然短缺，可能会影响急诊科的医疗质量。制定有效的应对策略仍然是一个具有挑战性的研究领域。我们创建了一个使用信息通信技术（ICT）来应对突然短缺的新型系统，并对该系统进行了测试，以确定它是否能弥补短缺。
对2012年至2015年期间转诊至日本一家一级创伤中心的患者（n = 4890）进行了研究。我们评估了该系统是否无需使用电话或传呼机等其他方式就能确保有必要的医生，并将系统的完成率作为主要结局变量进行计算。在系统引入前后的二次分析中，我们测试了转诊至急诊科的总伤亡人数中多人伤亡概率的差异，以此作为应对过多患者需求能力的指标。
该系统在24个月内被激活24次（待命请求[n = 12]，出勤请求[n = 12]），无需使用其他方式就确保了有必要的医生；完成率为100%。系统引入前后的工作日白天时段，多人伤亡概率没有显著差异，而系统引入后的夜间或周末时段，多人伤亡概率相比系统引入前显著增加（4.8%对12.9%，P < 0.0001）。总体而言，系统引入后多人伤亡概率增加了2倍多（6.2%对13.6%，P < 0.0001）。
引入该系统后，多人伤亡概率增加。因此，该系统可能有助于提高在多起伤亡事件中应对突然过多患者需求的能力。
一个使用ICT的新型系统成功地在不增加用户工作量的情况下确保了医院外所需医生的即时响应，并提高了应对过多患者需求的能力。该系统似乎能够弥补因患者转诊过多导致的急诊科医生短缺，尤其是在非工作时间。
