Lubin Jeffrey S, Shah Akash
Department of Emergency Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, USA.
Department of Public Health Sciences, Penn State College of Medicine, Hershey, USA.
Cureus. 2022 Feb 21;14(2):e22446. doi: 10.7759/cureus.22446. eCollection 2022 Feb.
Transition of care from Emergency Medical Services (EMS) to the Emergency Department (ED) represents an intersection at high risk for error. Minimal research has quantitatively examined data transfer at this point. In Pennsylvania, this handoff consists of a transfer-of-care form (TOC) provided by EMS to ED in addition to a verbal report. A prehospital patient care report (PCR) is later filed by EMS up to 72 hours after concluding care.
To evaluate the congruence between prehospital records provided at handoff and the final PCR found in the patient's medical record. Our hypothesis was that there would be discrepancies between the TOC and final PCR.
A retrospective chart review was conducted comparing the TOC from a single EMS agency to the final PCR found in the electronic medical record. A convenience sample of 200 patients who received advanced life support transport over a one-month period were included. Metrics to assess the discrepancy between the reports included chief complaint, allergies, medications, systolic and diastolic blood pressure (SBP and DBP), pulse, respiratory rate (RR), Glasgow Coma Score (GCS), and prehospital treatment provided. The level of agreement between the two sources was compared using kappa statistics and concordance correlation coefficients (CCC) with 95% confidence intervals.
Of the 200 encounters that met inclusion criteria, 72% had matching chief complaints between the TOC and PCR. Medications matched in 66% and allergies matched in 82%. Up to three BP, pulse, and RR readings were collected; only 30% of the third BP readings were available from the TOC, while 68% were available from the PCR. Comparing the three SBP values on the TOC to respective counterparts on the PCR showed a substantial correlation (all CCC >0.95). Pulse and DBP values had moderate-to-substantial correlation (CCC: 0.93, 0.94, 0.96 and 0.77, 0.92, 0.94 respectively). RR showed inconsistent correlation (CCC: 0.37, 0.84, 0.94). GCS showed a moderate correlation between the two forms (CCC: 0.81).
There were significant differences between the information transferred to the ED through the TOC compared to what was recorded in the PCR. Further evaluation of the TOC process is needed to improve accuracy.
从紧急医疗服务（EMS）到急诊科（ED）的护理交接是一个高错误风险的交叉点。目前极少有研究对这一环节的数据传递进行定量分析。在宾夕法尼亚州，这种交接除了口头报告外，还包括EMS向ED提供的护理交接表（TOC）。之后，EMS会在护理结束后72小时内提交一份院前患者护理报告（PCR）。
评估交接时提供的院前记录与患者病历中最终的PCR之间的一致性。我们的假设是TOC与最终的PCR之间会存在差异。
进行了一项回顾性图表审查，将单个EMS机构的TOC与电子病历中最终的PCR进行比较。纳入了在一个月内接受高级生命支持转运的200名患者的便利样本。评估报告之间差异的指标包括主诉、过敏史、用药情况、收缩压和舒张压（SBP和DBP）、脉搏、呼吸频率（RR）、格拉斯哥昏迷评分（GCS）以及提供的院前治疗。使用kappa统计量和一致性相关系数（CCC）以及95%置信区间来比较两个来源之间的一致程度。
在符合纳入标准的200次接诊中，72%的患者在TOC和PCR之间的主诉相匹配。用药情况匹配的占66%，过敏史匹配的占82%。收集了多达三次的血压、脉搏和RR读数；TOC中仅30%的第三次血压读数可用，而PCR中为68%。将TOC上的三个SBP值与PCR上的相应值进行比较，显示出高度相关性（所有CCC>0.95）。脉搏和DBP值具有中度到高度相关性（CCC分别为0.93、0.94、0.96和0.77、0.92、0.94）。RR显示出不一致的相关性（CCC为0.37、0.84、0.94）。GCS在两种表格之间显示出中度相关性（CCC为0.81）。
与PCR中记录的信息相比，通过TOC传递到ED的信息存在显著差异。需要对TOC流程进行进一步评估以提高准确性。
