Lee A, Lum M E, Beehan S J, Hillman K M
Department of Anaesthetics and Intensive Care, Liverpool Hospital, New South Wales, Australia.
Crit Care Med. 1996 Apr;24(4):618-22. doi: 10.1097/00003246-199604000-00012.
To evaluate the training of clinical staff in the use of interhospital transfer guidelines and to examine the underlying decision-making behavior in organizing patient transfers between hospitals.
Prospective assessment of clinical scenarios, given before (time 1), immediately after (time 2), and 3 months after (time 3) a program informing clinical staff about the use of interhospital transfer guidelines.
Three emergency departments and one intensive care unit at three hospitals and a medical retrieval service in Sydney, Australia.
Physicians, nurses, and a paramedic working in critical care areas and at a medical retrieval service.
A questionnaire containing clinical scenarios was administered to clinical staff. There was a significant difference in mean scores for selecting the appropriate escort levels across time (F2,78 = 24.2; p < .01) and for participant's experience with interhospital transfer (F2,39 = 4.63; p = .02). Significant improvement in mean scores occurred between time 1 (7.55 +/- 1.84 and time 2 (9.48 +/- 1.47) (t41 = -6.21; p < .01). The improvement in selecting appropriate escorts was maintained at time 3 (mean score 9.86 +/- 2.01). The error rate for inappropriate assignment of low levels of escorts decreased from 35% (time 1) to 10% (time 2) and 14% (time 3). Using conjoint analysis, there were large variations in the decision-making behaviour between each time period. The relative importance of each factor in influencing the decision to organize an escort at time 3 were as follows: treatment (43%); physiology (29%); patient age (24%); and diagnosis (4%). The decision-making model observed at time 3 had a high predictive value (87%) as compared with the model at time 1 (48%).
Clinical staff can make informed and appropriate decisions by using standardized guidelines when organizing interhospital transfers.
评估临床工作人员在使用医院间转运指南方面的培训情况，并研究在组织患者医院间转运过程中潜在的决策行为。
对临床情景进行前瞻性评估，分别在向临床工作人员介绍医院间转运指南的项目开展前（时间1）、刚结束后（时间2）以及3个月后（时间3）进行。
澳大利亚悉尼的三家医院的三个急诊科、一个重症监护病房以及一项医疗检索服务机构。
在重症监护领域及医疗检索服务机构工作的医生、护士和一名护理人员。
向临床工作人员发放包含临床情景的问卷。在不同时间选择合适护送级别的平均得分存在显著差异（F2,78 = 24.2；p <.01），参与者在医院间转运方面的经验得分也存在显著差异（F2,39 = 4.63；p =.02）。平均得分在时间1（7.55 +/- 1.84）和时间2（9.48 +/- 1.47）之间有显著提高（t41 = -6.21；p <.01）。在时间3时，选择合适护送人员的情况保持改善（平均得分9.86 +/- 2.01）。低级别护送人员分配不当的错误率从时间1的35%降至时间2的10%和时间3的14%。采用联合分析，每个时间段的决策行为存在很大差异。在时间3时，各因素对组织护送决策的相对重要性如下：治疗（43%）；生理状况（29%）；患者年龄（24%）；诊断（4%）。与时间1的模型（48%）相比，时间3观察到的决策模型具有较高的预测价值（87%）。
临床工作人员在组织医院间转运时，通过使用标准化指南能够做出明智且恰当的决策。
