Department of Emergency Medicine, Yonsei University College of Medicine, Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
Am J Emerg Med. 2019 Mar;37(3):395-400. doi: 10.1016/j.ajem.2018.05.060. Epub 2018 May 29.
Patients who cannot be stabilized at a lower-level emergency department (ED) should be transferred to an upper-level ED by emergency medical services. However, some patients are subsequently discharged after transfer without any intervention or admission, and this secondary overtriage (SO) wastes the limited resources of upper-level EDs. This study aimed to investigate whether an emergency transfer coordination center (ETCC) could reduce the risk of SO among patients who were transferred to a tertiary ED by emergency medical services.
This retrospective observational study evaluated data from a prospective registry at an urban tertiary ED in Korea (January 2017 to May 2017). The exposure of interest was defined as ETCC approval prior to transfer and the primary outcome was SO. Univariate analyses were used to identify statistically significant variables, which were used for a multivariate logistic regression analysis to estimate the effects of ETCC approval on SO.
During the study period, 1270 patients were considered eligible for this study. A total of 291 transfers were approved by the center's ETCC, and the remaining patients were transferred without approval. Compared to cases without ETCC approval, cases with transfer after ETCC approval had a significantly lower risk of SO (odds ratio: 0.624, 95% confidence interval: 0.413-0.944).
Transfers that were evaluated by an ETCC had a lower risk of SO, which may improve the appropriateness of transfer. Thus, tertiary EDs that have high proportions of transferred patients should have a transfer coordination system that is similar to an ETCC.
无法在低级别急诊部（ED）稳定病情的患者应由急救医疗服务机构转送至更高级别的 ED。然而，一些患者在转院后并未接受任何干预或入院便被再次转出，这种二次过度分诊（SO）浪费了高级别 ED 的有限资源。本研究旨在探讨急救转运协调中心（ETCC）是否可以降低通过急救医疗服务机构转送至三级 ED 的患者发生 SO 的风险。
这是一项在韩国一家城市三级 ED 进行的回顾性观察性研究（2017 年 1 月至 2017 年 5 月）。本研究的暴露因素定义为转运前 ETCC 批准，主要结局为 SO。采用单因素分析来识别具有统计学意义的变量，然后采用多因素 logistic 回归分析来评估 ETCC 批准对 SO 的影响。
在研究期间，共有 1270 名患者符合本研究的纳入标准。中心 ETCC 共批准了 291 例转运，其余患者未经批准便进行了转运。与未经 ETCC 批准的病例相比，经 ETCC 批准后转运的病例发生 SO 的风险显著降低（比值比：0.624，95%置信区间：0.413-0.944）。
经 ETCC 评估的转运患者发生 SO 的风险较低，这可能会提高转运的适宜性。因此，转院患者比例较高的三级 ED 应建立类似于 ETCC 的转运协调系统。
