Kim Ji Hoon, Kim Min Joung, You Je Sung, Song Mi Kyung, Cho Sung Il
Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Epidemiology, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea.
Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
J Emerg Med. 2018 Mar;54(3):287-294. doi: 10.1016/j.jemermed.2017.08.013. Epub 2017 Oct 23.
Until recently, there have been few studies on the transfer of patients from emergency departments (EDs) overall, as such studies were limited primarily to trauma patients.
The purpose of this study was to investigate the association between the specialty of the primary referring physician and the appropriateness of the emergency transfer (AET).
This was a retrospective, observational study performed at two level-3 EDs in a rural area. A transfer to a higher-level ED for the purpose of patient stabilization was defined as an emergency transfer, and transfers were classified as "appropriate" when the emergency status of the patient could not be resolved by the referring ED. The primary outcome was AET, which was reviewed by an expert panel for reliability. Statistically significant variables were selected as covariates based on the results of a univariate analysis, and a multivariate logistic regression analysis was performed to estimate the odds ratios (ORs) with 95% confidence intervals (CIs) on the AET.
A total of 1325 patients underwent transfer to another hospital from the two EDs. Of these, 1003 were classified into the emergency transfer group. In both EDs, the incidence of appropriate emergency transfers was significantly higher when the primary referring physician was an emergency physician (OR 4.005, 95% CI 2.619-6.125 and OR 4.006, 95% CI 1.696-9.459 for each hospital, respectively).
There was a positive association between the specialty of the primary referring physician and the AET among EDs located in rural areas making patient transfers.
直到最近，关于急诊科患者转诊的研究总体上还很少，因为此类研究主要局限于创伤患者。
本研究的目的是调查首诊医师的专业与急诊转诊适宜性（AET）之间的关联。
这是一项在农村地区两家三级急诊科进行的回顾性观察研究。为使患者病情稳定而转诊至上级急诊科被定义为急诊转诊，当转诊急诊科无法解决患者的紧急状况时，转诊被归类为“适宜”。主要结局是AET，由一个专家小组对其可靠性进行评估。根据单因素分析结果选择具有统计学意义的变量作为协变量，并进行多因素逻辑回归分析以估计AET的比值比（OR）及其95%置信区间（CI）。
共有1325名患者从两家急诊科转诊至另一家医院。其中，1003名被归入急诊转诊组。在两家急诊科中，当首诊医师为急诊医师时，适宜急诊转诊的发生率均显著更高（每家医院的OR分别为4.005，95%CI 2.619 - 6.125和OR 4.006，95%CI 1.696 - 9.459）。
在农村地区进行患者转诊的急诊科中，首诊医师的专业与AET之间存在正相关。
