优先评分对严重 COVID-19 患者院内转院时间管理的影响：一项准实验干预研究。
Effect of a prioritization score on the inter-hospital transfer time management of severe COVID-19 patients: a quasi-experimental intervention study.
机构信息
Area of Research and Development, Clinical Department, Sistema d'Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L'Hospitalet de Llobregat, Barcelona 08908, Spain.
Sociedad Española de Medicina de Urgencias y Emergencias, Red de Investigación de Emergencias Prehospitalarias RINVEMER, nuñez de balboa 116 3° office 9, Madrid 28020, Spain.
出版信息
Int J Qual Health Care. 2022 Mar 28;34(1). doi: 10.1093/intqhc/mzac011.
BACKGROUND
The overburdening of the healthcare system during the coronavirus disease 19 (COVID-19) pandemic is driving the need to create new tools to improve the management of inter-hospital transport for patients with a severe COVID-19 infection.
OBJECTIVE
The aim of this study was to analyse the usefulness of the application of a prioritization score (IHTCOVID-19) for inter-hospital transfer of patients with COVID-19 infection.
METHODS
The study has a quasi-experimental design and was conducted on the Medical Emergency System, the pre-hospital emergency department of the public company belonging to the Autonomous Government of Catalonia that manages urgent healthcare in the region. Patients with a severe COVID-19 infection requiring inter-hospital transport were consecutively included. The pre-intervention period was from 1 to 31 March 2020, and the intervention period with the IHTCOVID-19 score was from 1 to 30 April 2020 (from 8 am to 8 pm). The prioritization score comprises four priority categories, with Priority 0 being the highest and Priority 3 being the lowest. Inter-hospital transfer (IHT) management times (alert-assignment time, resource management time and total central management time) and their variability were evaluated according to whether or not the IHTCOVID-19 score was applied.
RESULTS
A total of 344 IHTs were included: 189 (54.9%) in the pre-intervention period and 155 (45.1%) in the post-intervention period. The majority of patients were male and the most frequent age range was between 50 and 70 years. According to the IHTCOVID-19 score, 12 (3.5%) transfers were classified as Priority 0, 66 (19.4%) as Priority 1, 247 (71.8%) as Priority 2 and 19 (5.6%) as Priority 3. Overall, with the application of the IHTCOVID-19 score, there was a significant reduction in total central management time [from 112.4 (inter-quartile range (IQR) 281.3) to 89.8 min (IQR 154.9); P = 0.012]. This significant reduction was observed in Priority 0 patients [286.2 (IQR 218.5) to 42.0 min (IQR 58); P = 0.018] and Priority 1 patients [130.3 (IQR 297.3) to 75.4 min (IQR 91.1); P = 0.034]. After applying the IHTCOVID-19 score, the average time of the process decreased by 22.6 min, and variability was reduced from 618.1 to 324.0 min.
CONCLUSION
The application of the IHTCOVID-19 score in patients with a severe COVID-19 infection reduces IHT management times and variability.
背景
在 2019 年冠状病毒病（COVID-19）大流行期间，医疗系统负担过重，这促使我们需要创建新的工具来改进严重 COVID-19 感染患者的院内转院管理。
目的
本研究旨在分析应用 COVID-19 院内转院优先排序评分（IHTCOVID-19）对 COVID-19 感染患者院内转院的有用性。
方法
该研究采用准实验设计，在隶属于加泰罗尼亚自治区自治政府的公共公司的医疗急救系统（该系统是该地区紧急医疗服务的院前急救部门）上进行。连续纳入需要院内转院的严重 COVID-19 感染患者。预干预期为 2020 年 3 月 1 日至 31 日，干预期采用 IHTCOVID-19 评分，时间为 2020 年 4 月 1 日至 30 日（上午 8 点至晚上 8 点）。优先排序评分包括四个优先类别，优先级 0 最高，优先级 3 最低。根据是否应用 IHTCOVID-19 评分，评估院内转院（IHT）管理时间（警报分配时间、资源管理时间和中央管理总时间）及其变异性。
结果
共纳入 344 例 IHT：干预前 189 例（54.9%），干预后 155 例（45.1%）。大多数患者为男性，最常见的年龄范围在 50 至 70 岁之间。根据 IHTCOVID-19 评分，12 例（3.5%）转院被归类为优先级 0，66 例（19.4%）为优先级 1，247 例（71.8%）为优先级 2，19 例（5.6%）为优先级 3。总体而言，应用 IHTCOVID-19 评分后，中央管理总时间显著缩短[从 112.4（四分位距（IQR）281.3）减少至 89.8 分钟（IQR 154.9）；P=0.012]。这一显著缩短在优先级 0 患者中观察到[从 286.2（IQR 218.5）减少至 42.0 分钟（IQR 58）；P=0.018]和优先级 1 患者中观察到[从 130.3（IQR 297.3）减少至 75.4 分钟（IQR 91.1）；P=0.034]。应用 IHTCOVID-19 评分后，平均处理时间缩短了 22.6 分钟，变异性从 618.1 分钟减少至 324.0 分钟。
结论
在严重 COVID-19 感染患者中应用 IHTCOVID-19 评分可缩短 IHT 管理时间和变异性。
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