挪威东南部创伤护理中医生紧急医疗服务的调度准确性:一项回顾性观察研究。

Martin Samdal, Kjetil Thorsen, Ola Græsli, Mårten Sandberg, Marius Rehn
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引用次数: 3

摘要

背景:选择事件和准确识别需要医生紧急医疗服务(P-EMS)援助的患者仍然至关重要。我们的目的是评估2015年挪威东南部创伤护理的P-EMS可用性、潜在的调度标准和相应的调度准确性,以确定需要改进的领域。方法:将来自紧急医疗协调中心和P-EMS医疗数据库的院前数据与挪威创伤登记处(NTR)的数据相关联。根据一系列条件(损伤严重程度、实施的干预措施、意识水平、事件类别),创伤事件被定义为复杂的、需要P-EMS援助的或非复杂的。事件复杂性和P-EMS参与是评估分诊准确性的主要决定因素。分流不足是根据紧急医疗服务的可用性、响应和运输时间进行调整的。结果:19028例外伤中有2506例(13.2%)涉及急诊急救。过度分诊率为74 ~ 80%,不足分诊率为20 ~ 32%。P-EMS在发生复杂事件时的准备程度从58%到70%不等。在4321宗(22.7%)事故中,最常见的调度准则是“警察/消防队要求即时回应”。在10,875宗(57.2%)事件中记录了“意外”和“道路交通意外”组别的准则,在6025宗(31.7%)事件中记录了“运输预约”和“不明问题”组别的准则。在NTR的4916例患者通路中,681例(13.9%)无法与院前数据记录匹配。结论:在挪威东南部的创伤护理中,P-EMS的可用性和调度准确性仍然不理想。调度标准过于模糊,不利于精准的P-EMS调度,院前数据不一致,不足以为科学研究提供基础数据。未来的调度标准应侧重于P-EMS的护理方面。紧急医疗协调中心必须有更好的调度和事件处理工具。总的来说,现有数据系统的协调、标准化和整合应能提高创伤护理的质量并增加患者的安全。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Dispatch accuracy of physician-staffed emergency medical services in trauma care in south-east Norway: a retrospective observational study.

Dispatch accuracy of physician-staffed emergency medical services in trauma care in south-east Norway: a retrospective observational study.

Dispatch accuracy of physician-staffed emergency medical services in trauma care in south-east Norway: a retrospective observational study.

Dispatch accuracy of physician-staffed emergency medical services in trauma care in south-east Norway: a retrospective observational study.

Background: Selection of incidents and accurate identification of patients that require assistance from physician-staffed emergency medical services (P-EMS) remain essential. We aimed to evaluate P-EMS availability, the underlying criteria for dispatch, and the corresponding dispatch accuracy of trauma care in south-east Norway in 2015, to identify areas for improvement.

Methods: Pre-hospital data from emergency medical coordination centres and P-EMS medical databases were linked with data from the Norwegian Trauma Registry (NTR). Based on a set of conditions (injury severity, interventions performed, level of consciousness, incident category), trauma incidents were defined as complex, warranting P-EMS assistance, or non-complex. Incident complexity and P-EMS involvement were the main determinants when assessing the triage accuracy. Undertriage was adjusted for P-EMS availability and response and transport times.

Results: Among 19,028 trauma incidents, P-EMS were involved in 2506 (13.2%). The range of overtriage was 74-80% and the range of undertriage was 20-32%. P-EMS readiness in the event of complex incidents ranged from 58 to 70%. The most frequent dispatch criterion was "Police/fire brigade request immediate response" recorded in 4321 (22.7%) of the incidents. Criteria from the groups "Accidents" and "Road traffic accidents" were recorded in 10,875 (57.2%) incidents, and criteria from the groups "Transport reservations" and "Unidentified problem" in 6025 (31,7%) incidents. Among 4916 patient pathways in the NTR, 681 (13.9%) could not be matched with pre-hospital data records.

Conclusions: Both P-EMS availability and dispatch accuracy remain suboptimal in trauma care in south-east Norway. Dispatch criteria are too vague to facilitate accurate P-EMS dispatch, and pre-hospital data is inconsistent and insufficient to provide basic data for scientific research. Future dispatch criteria should focus on the care aspect of P-EMS. Better tools for both dispatch and incident handling for the emergency medical coordination centres are essential. In general, coordination, standardisation, and integration of existing data systems should enhance the quality of trauma care and increase patient safety.

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