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从患者安全和专业角度看待救护车转运中的非转运问题:系统综述。

A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review.

机构信息

Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Faculty of Health and Social Studies, PO Box 6960, 6503, GL, Nijmegen, The Netherlands.

Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands.

出版信息

Scand J Trauma Resusc Emerg Med. 2017 Jul 17;25(1):71. doi: 10.1186/s13049-017-0409-6.

Abstract

BACKGROUND

This systematic review aimed to describe non-conveyance in ambulance care from patient-safety and ambulance professional perspectives. The review specifically focussed at describing (1) ambulance non-conveyance rates, (2) characteristics of non-conveyed patients, (3) follow-up care after non-conveyance, (4) existing guidelines or protocols, and (5) influencing factors during the non-conveyance decision making process.

METHODS

We systematically searched MEDLINE, PubMed, CINAHL, EMBASE, and reference lists of included articles, in June 2016. We included all types of peer-reviewed designs on the five topics. Couples of two independent reviewers performed the selection process, the quality assessment, and data extraction.

RESULTS

We included 67 studies with low to moderate quality. Non-conveyance rates for general patient populations ranged from 3.7%-93.7%. Non-conveyed patients have a variety of initial complaints, common initial complaints are related to trauma and neurology. Furthermore, vulnerable patients groups as children and elderly are more represented in the non-conveyance population. Within 24 h-48 h after non-conveyance, 2.5%-6.1% of the patients have EMS representations, and 4.6-19.0% present themselves at the ED. Mortality rates vary from 0.2%-3.5% after 24 h, up to 0.3%-6.1% after 72 h. Criteria to guide non-conveyance decisions are vital signs, ingestion of drugs/alcohol, and level of consciousness. A limited amount of non-conveyance guidelines or protocols is available for general and specific patient populations. Factors influencing the non-conveyance decision are related to the professional (competencies, experience, intuition), the patient (health status, refusal, wishes and best interest), the healthcare system (access to general practitioner/other healthcare facilities/patient information), and supportive tools (online medical control, high risk card).

CONCLUSIONS

Non-conveyance rates for general and specific patient populations vary. Patients in the non-conveyance population present themselves with a variety of initial complaints and conditions, common initial complaints or conditions are related to trauma and neurology. After non-conveyance, a proportion of patients re-enters the emergency healthcare system within 2 days. For ambulance professionals the non-conveyance decision-making process is complex and multifactorial. Competencies needed to perform non-conveyance are marginally described, and there is a limited amount of supportive tools is available for general and specific non-conveyance populations. This may compromise patient-safety.

摘要

背景

本系统评价旨在从患者安全和救护车专业人员的角度描述救护车护理中的非转运情况。本评价特别侧重于描述(1)救护车非转运率,(2)未转运患者的特征,(3)非转运后的随访护理,(4)现有指南或方案,以及(5)非转运决策过程中的影响因素。

方法

我们于 2016 年 6 月系统地检索了 MEDLINE、PubMed、CINAHL、EMBASE 和纳入文章的参考文献列表。我们纳入了关于这五个主题的所有类型的同行评审设计。两名独立的审查员进行了选择过程、质量评估和数据提取。

结果

我们纳入了 67 项研究,质量为低到中等。一般患者人群的非转运率为 3.7%-93.7%。未转运的患者有各种初始症状,常见的初始症状与创伤和神经病学有关。此外,儿童和老年人等脆弱患者群体在非转运人群中更为常见。非转运后 24 小时至 48 小时内,有 2.5%-6.1%的患者接受了 EMS 代表的治疗,4.6-19.0%的患者自行前往 ED。24 小时后死亡率为 0.2%-3.5%,72 小时后死亡率为 0.3%-6.1%。指导非转运决策的标准是生命体征、摄入药物/酒精和意识水平。一般和特定患者人群的非转运指南或方案数量有限。影响非转运决策的因素与专业人员(能力、经验、直觉)、患者(健康状况、拒绝、意愿和最佳利益)、医疗保健系统(获得全科医生/其他医疗保健设施/患者信息)和支持工具(在线医疗控制、高危卡)有关。

结论

一般和特定患者人群的非转运率各不相同。非转运人群中的患者表现出各种初始症状和情况,常见的初始症状或情况与创伤和神经病学有关。非转运后,在 2 天内,一部分患者重新进入急诊医疗保健系统。对于救护车专业人员来说,非转运决策过程是复杂的,并且是多方面的。执行非转运所需的能力仅略有描述,并且一般和特定非转运人群的支持工具数量有限。这可能会危及患者安全。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/15b0/5513207/7ab3029599bc/13049_2017_409_Fig1_HTML.jpg

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