Trauma, Texas Health Harris Methodist Hospital Fort Worth, Fort Worth, Texas, USA
Neuro-Trauma, Texas Health Harris Methodist Hospital Fort Worth, Fort Worth, Texas, USA.
BMJ Open Qual. 2023 Mar;12(1). doi: 10.1136/bmjoq-2022-002012.
Mild traumatic brain injuries (MTBI) associated with intracranial haemorrhage are commonly transferred to tertiary care centres. Recent studies have shown that transfers for low-severity traumatic brain injuries may be unnecessary. Trauma systems can be overwhelmed by low acuity patients justifying standardisation of MTBI transfers. We sought to evaluate the impact of telemedicine services on mitigating unnecessary transfers for those presenting with low-severity blunt head trauma after sustaining a ground level fall (GLF).
A process improvement plan was developed by a task force of transfer centre (TC) administrators, emergency department physicians (EDP), trauma surgeons and neurosurgeons (NS) to facilitate the requesting EDP and the NS on-call to converse directly to mitigate unnecessary transfers. Consecutive retrospective chart review was performed on neurosurgical transfer requests between 1 January 2021 and 31 January 2022. A comparison of transfers preintervention and postintervention (1 January 2021 to 12 September 2021)/(13 September 2021 to 31 January 2022) was performed.
The TC received 1091 neurological-based transfer requests during the study period (preintervention group: 406 neurosurgical requests; postintervention group: 353 neurosurgical requests). After consultation with the NS on-call, the number of MTBI patients remaining at their respective ED's with no neurological degradation more than doubled from 15 in the preintervention group to 37 in the postintervention group.
TC-mediated telemedicine conversations between the NS and the referring EDP can prevent unnecessary transfers for stable MTBI patients sustaining a GLF if needed. Outlying EDPs should be educated on this process to increase efficacy.
与颅内出血相关的轻度创伤性脑损伤（MTBI）通常会被转至三级护理中心。最近的研究表明，对于低严重程度的创伤性脑损伤的转院可能是不必要的。创伤系统可能会被低 acuity 患者淹没，这证明了 MTBI 转院的标准化是合理的。我们试图评估远程医疗服务对减轻因地面水平坠落（GLF）导致的低严重程度钝性头部创伤后出现的不必要转院的影响。
一个由转院中心（TC）管理员、急诊部医生（EDP）、创伤外科医生和神经外科医生（NS）组成的工作组制定了一个改进计划，以方便请求 EDP 和 NS 值班医生直接沟通，以减轻不必要的转院。对 2021 年 1 月 1 日至 2022 年 1 月 31 日期间神经外科转院请求进行了连续回顾性图表审查。比较了干预前（2021 年 1 月 1 日至 2021 年 9 月 12 日）和干预后（2021 年 9 月 13 日至 2022 年 1 月 31 日）的转院情况。
在研究期间，TC 共收到 1091 份神经科为基础的转院请求（干预前组：406 份神经外科请求；干预后组：353 份神经外科请求）。在与 NS 值班医生咨询后，需要留在各自 ED 且无神经恶化的 MTBI 患者数量增加了一倍多，从干预前组的 15 例增加到干预后组的 37 例。
如果需要，TC 介导的 NS 和转院 EDP 之间的远程医疗对话可以防止稳定的 MTBI 患者因 GLF 而进行不必要的转院。应向偏远 EDP 教育这一过程，以提高效率。
