Narendra P L, Hegde Harihar V, Khan Maroof Ahmad, Talikoti Dayanand G, Nallamilli Samson
Department of Anesthesiology, Subbaiah Institute of Medical Sciences, Shivamogga, Karnataka, India.
Department of Anesthesiology, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India.
Anesth Essays Res. 2017 Jul-Sep;11(3):702-712. doi: 10.4103/0259-1162.207072.
Anesthetists come in contact with more than two-third of hospital patients. Timely referral to anesthetists is vital in perioperative and remote site settings. Delayed referrals, improper referrals, and referrals at inappropriate levels can result in inadequate preparation, perioperative complications, and poor outcome.
The self administered paper survey to delegates attending anesthesia conferences. Questions were asked on how high-risk, emergency surgical cases remote site and critical care patients were referred to anesthetists and presence of rapid response teams.
The response rate was 43.8%. Sixty percent (55.3-64.8, - 0.001) reported high-risk elective cases were referred after admission. Sixty-eight percent (63.42-72.45, - 0.001) opined preoperative resting echocardiographs were useful. Six percent (4.16-8.98, - 0.001) reported emergency room referral before arrival of the patient. Twenty-five percent (20.92-29.42, - 0.001) indicated high-risk obstetric cases were referred immediately after admission. Consultants practiced preoperative stabilization more commonly than residents (32% vs. 22%) ( - 0.004). For emergency surgery, resident referrals occurred after surgery time was fixed (40% vs. 28%) ( - 0.012). Residents dealt with more cases without full investigations in obstetrics (28% vs. 15) ( = 0.002). Remote site patients were commonly referred to residents after sedation attempts (32% vs. 20%) ( = 0.036). Only 34.8 said hosptals where tbey practiced had dedicated cardiac arrest team in place.
Anesthetic departments must periodically assess whether subgroups of patients are being referred in line with current guidelines. Cancellations, critical incidents and complications arising out of referral delays, and improper referrals must be recorded as referral incidents and a separate referral incident registry must be maintained in each department. Regular referral audits must be encouraged.
麻醉医生接触到超过三分之二的住院患者。在围手术期和偏远地区，及时将患者转介给麻醉医生至关重要。转介延迟、不当转介以及在不适当级别进行转介可能导致准备不足、围手术期并发症和不良后果。
对参加麻醉会议的代表进行自行填写的纸质调查。询问了关于高危、急诊手术病例、偏远地区患者和重症监护患者如何转介给麻醉医生以及快速反应小组的情况。
回复率为43.8%。60%（55.3 - 64.8，P < 0.001）报告高危择期病例在入院后才被转介。68%（63.42 - 72.45，P < 0.001）认为术前静息超声心动图有用。6%（4.16 - 8.98，P < 0.001）报告在患者到达之前就在急诊室进行了转介。25%（20.92 - 29.42，P < 0.001）表示高危产科病例在入院后立即被转介。顾问医生比住院医生更常进行术前稳定治疗（32%对22%）（P = 0.004）。对于急诊手术，住院医生在手术时间确定后才进行转介（40%对28%）（P = 0.012）。住院医生处理的产科病例中未进行全面检查的更多（28%对15%）（P = 0.002）。偏远地区患者在尝试镇静后通常被转介给住院医生（32%对20%）（P = 0.036）。只有34.8%表示他们工作的医院有专门的心脏骤停团队。
麻醉科必须定期评估患者亚组的转介是否符合当前指南。因转介延迟和不当转介导致的取消手术、严重事件和并发症必须记录为转介事件，每个科室必须维护一个单独的转介事件登记册。必须鼓励定期进行转介审核。
