Accident and Emergency, Kigali University Teaching Hospital, Kigali, Rwanda.
Department of Anesthesia, Emergency Medicine and Critical Care, University of Rwanda, Kigali, Rwanda.
Prehosp Disaster Med. 2023 Aug;38(4):456-462. doi: 10.1017/S1049023X23005927. Epub 2023 Jun 21.
Treatment of seriously ill patients is often complicated by prolonged or complex transfers between hospitals in sub-Saharan Africa. Difficulties or inefficiency in these transfers can lead to poor outcomes for patients. "On-call" triage systems have been utilized to facilitate communication between facilities and to avoid poor outcomes associated with patient transfer. This study attempts to examine the effects of a pilot study to implement such a system in Rwanda.
Data collection occurred prospectively in two stages, pre-intervention and intervention, in the emergency department (ED) at Kigali University Teaching Hospital (CHUK). All patients transferred during the pre-determined timeframe were enrolled. Data were collected by ED research staff via a standardized form. Statistical analysis was performed using STATA version 15.0. Differences in characteristics were assessed using χ or Fisher's exact tests for categorical variables and independent sample t-tests for normally distributed continuous variables.
During the "on call" physician intervention, the indication for transfer was significantly more likely to be for critical care (P <.001), transfer times were faster (P <.001), patients were more likely to be displaying emergency signs (P <.001), and vital signs were more likely to be collected prior to transport (P <.001) when compared to the pre-interventional phase.
The "[Emergency Medicine] EM Doc On Call" intervention was associated with improved timely interhospital transfer and clinical documentation in Rwanda. While these data are not definitive due to multiple limitations, it is extremely promising and worthy of further study.
在撒哈拉以南非洲，治疗重病患者往往会因医院之间的长时间或复杂转移而变得复杂。这些转移中的困难或效率低下可能导致患者的治疗结果不佳。“随叫随到”分诊系统已被用于促进医疗机构之间的沟通，并避免与患者转移相关的不良结果。本研究试图考察在卢旺达实施此类系统的试点研究的效果。
数据收集分两个阶段进行，在基加利大学教学医院（CHUK）的急诊科进行前瞻性预干预和干预。所有在预定时间范围内转移的患者均被纳入研究。ED 研究人员通过标准化表格收集数据。使用 STATA 版本 15.0 进行统计分析。使用 χ 或 Fisher 精确检验对分类变量进行特征差异评估，对正态分布的连续变量进行独立样本 t 检验。
在“随叫随到”医生干预期间，转移的指征更有可能是重症监护（P<.001），转移时间更快（P<.001），患者更有可能出现紧急症状（P<.001），并且在运输前更有可能收集生命体征（P<.001），与干预前相比。
“[急诊医学]急诊医生随叫随到”干预措施与卢旺达医院间及时转移和临床记录的改善有关。尽管由于存在多种限制，这些数据并不具有确定性，但它非常有前途，值得进一步研究。
