Bartolacci John, Goldstein Judah, Kiberd Bryce, Swain Janel, Vinson Amanda, Clark David, Tennankore Karthik K
Prehosp Emerg Care. 2018 Nov-Dec;22(6):698-704. doi: 10.1080/10903127.2018.1454558. Epub 2018 Apr 19.
Patients receiving chronic dialysis often require emergent and inpatient care; however, only a minimal amount is known about their out-of-hospital/inter-hospital use of Emergency Medical Services (EMS). The purpose of this study was to describe the utilization of EMS in a cohort of dialysis patients.
We analyzed a cohort of adult (≥18 years) chronic dialysis patients within the Nova Scotia Health Authority Central Zone Renal Program who initiated chronic dialysis between January 1, 2009 and June 30, 2013 (last follow up July 1, 2015). Dialysis patient data was linked to regional EMS data. Requests for EMS, including encounter type, day of the week, and patient characteristics were described.
The cohort consisted of 468 patients of whom 79% (N = 361) had an EMS encounter. There were a total of 8,774 EMS encounters for the entire cohort. Patients who had an EMS encounter tended to be older (64 ± 14 years), compared to those without an encounter (55 ± 16 years, P < 0.001) and also had a higher burden of comorbidity. Transfers (including those between facilities) accounted for 89% of all encounters (N = 7,826), followed by emergency department (ED) transports (N = 749, 9%). Overall, 79% of all non-transfers underwent transport to the ED. For patients receiving thrice weekly in-center hemodialysis, the highest EMS utilization for ED transport occurred on the first hemodialysis day after the long dialysis break (22%, P < 0.01). The lowest proportion of ED transports occurred on the day after hemodialysis day 3.
Utilization of EMS services by dialysis patients is considerable, particularly for transfers. This highlights a potential area to be targeted for reducing resource utilization. Calls requiring transport to the ED occurred most often on Mondays and Tuesdays, the day after the long-dialysis break, and may represent a time of heightened risk for in-center hemodialysis patients.
接受长期透析的患者经常需要紧急和住院治疗；然而，对于他们在院外/医院间使用紧急医疗服务（EMS）的情况了解甚少。本研究的目的是描述一组透析患者对EMS的使用情况。
我们分析了新斯科舍省卫生局中区肾脏项目中在2009年1月1日至2013年6月30日期间开始进行长期透析的成年（≥18岁）慢性透析患者队列（最后随访时间为2015年7月1日）。透析患者数据与区域EMS数据相关联。描述了对EMS的请求，包括遭遇类型、星期几以及患者特征。
该队列由468名患者组成，其中79%（N = 361）有过EMS遭遇。整个队列共有8774次EMS遭遇。有EMS遭遇的患者往往年龄较大（64±14岁），而没有遭遇的患者年龄为（55±16岁，P < 0.001），且合并症负担也更高。转运（包括机构间转运）占所有遭遇的89%（N = 7826），其次是急诊科（ED）转运（N = 749，9%）。总体而言，所有非转运患者中有79%被转运至急诊科。对于每周接受三次中心血液透析的患者，急诊转运的EMS利用率在长时间透析中断后的第一个血液透析日最高（22%，P < 0.01）。急诊转运比例最低的是在血液透析第3天后的那天。
透析患者对EMS服务的使用相当可观，尤其是在转运方面。这突出了一个可作为降低资源利用目标的潜在领域。需要转运至急诊科的呼叫最常发生在周一和周二，即长时间透析中断后的那天，这可能是中心血液透析患者风险增加的时期。
