Limits...
New Intervention Model of Regional Transfer Network System to Alleviate Crowding of Regional Emergency Medical Center.

Ahn JY, Ryoo HW, Park J, Kim JK, Lee MJ, Kim JY, Shin SD, Cha WC, Seo JS, Kim YA - J. Korean Med. Sci. (2016)

Bottom Line: We found that the median ED length of stay (LOS) decreased significantly from 3.68 hours (interquartile range [IQR], 1.85 to 9.73) to 3.20 hours (IQR, 1.62 to 8.33) in the patient group after implementation of the Regional Transfer Network System (RTNS) (P < 0.001).The results of multivariate analysis showed a negative association between implementation of the RTNS and ED LOS (beta coefficient -0.743; 95% confidence interval -0.914 to -0.572; P < 0.001).In conclusion, the ED LOS in the tertiary hospital decreased after implementation of the RTNS.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Korea .

ABSTRACT
Emergency department (ED) crowding is a serious problem in most tertiary hospitals in Korea. Although several intervention models have been established to alleviate ED crowding, they are limited to a single hospital-based approach. This study was conducted to determine whether the new regional intervention model could alleviate ED crowding in a regional emergency medical center. This study was designed as a "before and after study" and included patients who visited the tertiary hospital ED from November 2011 to October 2013. One tertiary hospital and 32 secondary hospitals were included in the study. A transfer coordinator conducted inter-hospital transfers from a tertiary hospital to a secondary hospital for suitable patients. A total of 1,607 and 2,591 patients transferred from a tertiary hospital before and after the study, respectively (P < 0.001). We found that the median ED length of stay (LOS) decreased significantly from 3.68 hours (interquartile range [IQR], 1.85 to 9.73) to 3.20 hours (IQR, 1.62 to 8.33) in the patient group after implementation of the Regional Transfer Network System (RTNS) (P < 0.001). The results of multivariate analysis showed a negative association between implementation of the RTNS and ED LOS (beta coefficient -0.743; 95% confidence interval -0.914 to -0.572; P < 0.001). In conclusion, the ED LOS in the tertiary hospital decreased after implementation of the RTNS.

No MeSH data available.


Related in: MedlinePlus

Hourly distribution of patients using the Regional Transfer Network System.The most frequent transfer-request time and actual transfer time were 08:00–09:00 and 09:00–10:00, respectively. Transfer request and actual transfer showed a decreasing trend after 18:00 hours.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4835610&req=5

Figure 3: Hourly distribution of patients using the Regional Transfer Network System.The most frequent transfer-request time and actual transfer time were 08:00–09:00 and 09:00–10:00, respectively. Transfer request and actual transfer showed a decreasing trend after 18:00 hours.

Mentions: The number of transfer-request patients who used the RTNS was 1,762. Except for 287 patients whose transfer was cancelled, transfer was completed for 1,475 patients. Monthly distribution of transferred patients through the RTNS was presented in Fig. 2. The cancellation of transfer through RTNS was that hospital selection by patients without RTNS was the most common reason, with 88 patients, followed by discharge (n = 70), desire to stay in tertiary hospital (n = 66), rejection by secondary hospital (n = 28), death (n = 8), hopeless home discharge (n = 5), transferred to other tertiary hospital (n = 3) and others (n = 19). The numbers of transferred hospitals were 275. The median of transferred patients per hospital and patients transferred to secondary hospitals participating in this study were 2 (IQR 1-4) and 14 (IQR 4.75-32), respectively. The numbers of patients transferred to secondary hospitals participating in this study through RTNS were 626, and their disposition was re-transfer of 6, death of 24 and discharge of the rest. The most frequent transfer-request time was 08:00–09:00 hours (197 cases), and the most frequent actual transfer time was 09:00–10:00 hours (178 cases). Transfer request and actual transfer showed a decreasing trend after 18:00 hours (Fig. 3). The ED was the most common place of transfer request, with 1,037 patients (70.3%), followed by general ward (n = 248, 16.8%), emergency ICU (n = 120, 8.1%), and emergency ward (n = 70, 4.7%). The emergency medicine department was the most common department of transfer request, with 971 patients (55.1%), followed by neurosurgery (n = 159, 9.0%), internal medicine (n = 146, 8.3%) and orthopaedic surgery (n = 136, 7.7%).


New Intervention Model of Regional Transfer Network System to Alleviate Crowding of Regional Emergency Medical Center.

Ahn JY, Ryoo HW, Park J, Kim JK, Lee MJ, Kim JY, Shin SD, Cha WC, Seo JS, Kim YA - J. Korean Med. Sci. (2016)

Hourly distribution of patients using the Regional Transfer Network System.The most frequent transfer-request time and actual transfer time were 08:00–09:00 and 09:00–10:00, respectively. Transfer request and actual transfer showed a decreasing trend after 18:00 hours.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4835610&req=5

Figure 3: Hourly distribution of patients using the Regional Transfer Network System.The most frequent transfer-request time and actual transfer time were 08:00–09:00 and 09:00–10:00, respectively. Transfer request and actual transfer showed a decreasing trend after 18:00 hours.
Mentions: The number of transfer-request patients who used the RTNS was 1,762. Except for 287 patients whose transfer was cancelled, transfer was completed for 1,475 patients. Monthly distribution of transferred patients through the RTNS was presented in Fig. 2. The cancellation of transfer through RTNS was that hospital selection by patients without RTNS was the most common reason, with 88 patients, followed by discharge (n = 70), desire to stay in tertiary hospital (n = 66), rejection by secondary hospital (n = 28), death (n = 8), hopeless home discharge (n = 5), transferred to other tertiary hospital (n = 3) and others (n = 19). The numbers of transferred hospitals were 275. The median of transferred patients per hospital and patients transferred to secondary hospitals participating in this study were 2 (IQR 1-4) and 14 (IQR 4.75-32), respectively. The numbers of patients transferred to secondary hospitals participating in this study through RTNS were 626, and their disposition was re-transfer of 6, death of 24 and discharge of the rest. The most frequent transfer-request time was 08:00–09:00 hours (197 cases), and the most frequent actual transfer time was 09:00–10:00 hours (178 cases). Transfer request and actual transfer showed a decreasing trend after 18:00 hours (Fig. 3). The ED was the most common place of transfer request, with 1,037 patients (70.3%), followed by general ward (n = 248, 16.8%), emergency ICU (n = 120, 8.1%), and emergency ward (n = 70, 4.7%). The emergency medicine department was the most common department of transfer request, with 971 patients (55.1%), followed by neurosurgery (n = 159, 9.0%), internal medicine (n = 146, 8.3%) and orthopaedic surgery (n = 136, 7.7%).

Bottom Line: We found that the median ED length of stay (LOS) decreased significantly from 3.68 hours (interquartile range [IQR], 1.85 to 9.73) to 3.20 hours (IQR, 1.62 to 8.33) in the patient group after implementation of the Regional Transfer Network System (RTNS) (P < 0.001).The results of multivariate analysis showed a negative association between implementation of the RTNS and ED LOS (beta coefficient -0.743; 95% confidence interval -0.914 to -0.572; P < 0.001).In conclusion, the ED LOS in the tertiary hospital decreased after implementation of the RTNS.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Korea .

ABSTRACT
Emergency department (ED) crowding is a serious problem in most tertiary hospitals in Korea. Although several intervention models have been established to alleviate ED crowding, they are limited to a single hospital-based approach. This study was conducted to determine whether the new regional intervention model could alleviate ED crowding in a regional emergency medical center. This study was designed as a "before and after study" and included patients who visited the tertiary hospital ED from November 2011 to October 2013. One tertiary hospital and 32 secondary hospitals were included in the study. A transfer coordinator conducted inter-hospital transfers from a tertiary hospital to a secondary hospital for suitable patients. A total of 1,607 and 2,591 patients transferred from a tertiary hospital before and after the study, respectively (P < 0.001). We found that the median ED length of stay (LOS) decreased significantly from 3.68 hours (interquartile range [IQR], 1.85 to 9.73) to 3.20 hours (IQR, 1.62 to 8.33) in the patient group after implementation of the Regional Transfer Network System (RTNS) (P < 0.001). The results of multivariate analysis showed a negative association between implementation of the RTNS and ED LOS (beta coefficient -0.743; 95% confidence interval -0.914 to -0.572; P < 0.001). In conclusion, the ED LOS in the tertiary hospital decreased after implementation of the RTNS.

No MeSH data available.


Related in: MedlinePlus