Friberg Morten Langfeldt, Rognås Leif
Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
The Pre-hospital Critical Care Service in Aarhus, Department of Pre-hospital Critical Care Service, Pre-hospital Medical Services, Central Denmark Region, Aarhus, Denmark.
BMJ Open. 2018 Jul 18;8(7):e019813. doi: 10.1136/bmjopen-2017-019813.
The primary objective was to estimate the incidence of patients in the Central Denmark Region triaged to bypass the local emergency department without being part of a predefined fast-track protocol. The secondary objective was to describe these triage decisions in more detail with regard to the most common diagnoses, incidence of direct referral sorted by the prehospital critical care team (PHCCT) and the destination hospital.
Retrospective descriptive study.
The emergency medical service in the Central Denmark Region primarily consists of emergency medical technician (EMT)-staffed ambulances and anaesthesiologist-EMT-staffed PHCCTs. Patients treated by the nine ground-based PHCCTs in the region constituted the study population. The inclusion criteria were all patients treated by the PHCCTs during 2013 and 2014. The exclusion criteria were interhospital transfers, and patients with ST-segment elevation myocardial infarction, stroke or were in active labour.
Incidence of prehospital critical care anaesthesiologist-initiated direct referral, prehospital tentative diagnoses and transport destination.
During the study period, the PHCCTs treated 39 396 patients and diverted 989 (2.5%) patients not covered by a predefined fast-track protocol to a specialised hospital department. ' (n=143), (n=105) and (n=78) were the most common prehospital tentative diagnoses, accounting for 33.0% of all diverted patients. In total, 943 (95.3%) of the PHCCT-diverted patients were diverted to a department at Aarhus University Hospital.
Our results demonstrate that in 1 out of 40 patient contacts, the anaesthesiologist-staffed PHCCTs in the Central Denmark Region divert critically ill and injured patients directly to a specialised hospital department, bypassing local emergency departments and potentially reducing time to definitive care for these patients. There may be a potential for increased referral of patients with no predefined fast-track directly to specialised departments in the Central Denmark Region.
主要目的是估计丹麦中部地区未遵循预定义快速通道方案而被分诊绕过当地急诊科的患者发生率。次要目的是更详细地描述这些分诊决策，包括最常见的诊断、由院前重症监护团队（PHCCT）进行的直接转诊发生率以及目的地医院。
回顾性描述性研究。
丹麦中部地区的紧急医疗服务主要由配备急救医疗技术员（EMT）的救护车和配备麻醉医生 - EMT的PHCCT组成。该地区9个地面PHCCT治疗的患者构成研究人群。纳入标准为2013年和2014年期间由PHCCT治疗的所有患者。排除标准为医院间转运患者，以及患有ST段抬高型心肌梗死、中风或处于分娩期的患者。
院前重症监护麻醉医生发起的直接转诊发生率、院前初步诊断和转运目的地。
在研究期间，PHCCT共治疗了39396名患者，将989名（2.5%）未涵盖在预定义快速通道方案内的患者直接转诊至专科医院科室。“（n = 143）、（n = 105）和（n = 78）是最常见的院前初步诊断，占所有转诊患者的33.0%。总共有943名（95.3%）由PHCCT转诊的患者被转诊至奥胡斯大学医院的科室。
我们的结果表明，在每40次患者接触中，丹麦中部地区配备麻醉医生的PHCCT会将危重伤病患者直接转诊至专科医院科室，绕过当地急诊科，这可能会减少这些患者获得确定性治疗的时间。在丹麦中部地区，可能存在将无预定义快速通道的患者更多地直接转诊至专科医院科室的潜力。
