Prediction of en-route complications during interfacility transport by outcome predictive scores in ED.

OBJECTIVE: The objective was to determine the accuracy of the outcome predictive scores (Modified Early Warning Score [MEWS]; Hypotension, Low Oxygen Saturation, Low Temperature, Abnormal ECG, Loss of Independence [HOTEL] score; and Simple Clinical Score [SCS]) in predicting en-route complications during interfacility transport (IFT) in emergency department. DESIGN: This was a retrospective cohort study. METHODS: All IFT cases by ambulances with either nurse-led or physician-led escort, occurring between 1 January 2011 and 31 December 2012, were included. Obstetric and pediatric cases (age < 18 years) were excluded. The condition of patients was quantified by using the predictive scores (MEWS, HOTEL, and SCS) at triage station and on ambulance departure. The accuracy of predictive scores was compared by the receiver operating characteristic (ROC) curves. RESULTS: A total of 659 cases were included. Seventeen cases had en-route complications (2.6%). The complication rate in physician-escorted transport (2.2%) was similar to that in nurse-escorted transport (2.6%). None of the 57 intubated cases had en-route complications. The area under the ROC curve for MEWS was 0.662 (triage) and 0.479 (departure). The accuracy of MEWS at triage was better than that at departure (P = .049). The area under the ROC curve for HOTEL was 0.613 (triage) and 0.597 (departure), and that for SCS was 0.6 (triage) and 0.568 (departure). In general, the predictive scores at triage were better than those on departure. CONCLUSION: None of the scores had good accuracy in prediction of en-route complications during IFT. MEWS at triage was among the best one already but was not ideal.

Resource implications of inter-facility transport between emergency departments in Hong Kong.

BACKGROUND: The Inter-facility Transport (IFT) service provided by the Emergency Department (ED) is a vital service in Hong Kong. Patients need to be rapidly transported over distances to access appropriate healthcare facilities. METHODS: This study aims 1. to examine the resource utilisation of IFT accompanied by ED staff and 2. to analyse the crude, fixed and variable costs of IFT. A retrospective review was conducted of all IFT from Alice Ho Miu Ling Nethersole Hospital in the New Territories of Hong Kong where ED staff accompanied patients from 1 January 2006 to 31 December 2008. Descriptive analysis was used to evaluate the crude, fixed and variable costs per year for providing an ED-based IFT service. RESULTS: There were 337 transports accompanied by either medical or nursing staff from the ED that accounted for around 2% of all IFT. The most common indication for mobilising the transport team was an unstable clinical condition that required neurosurgical care. The average transport service time was 57.7 min per transport (SD 11.0). Resource utilisation consisted of fixed and variable costs that summed up to a cost of HKD $87,224.3 (USD $11,182.6) per year and the crude cost of providing IFT service by the ED was HKD$852.2 (USD $109.3) per patient. CONCLUSION: The crude cost of providing IFT service by the ED was reasonable and acceptable.

Hospital preparedness for chemical and biological incidents in Hong Kong.

The risk of mass exposure to toxic substances has increased steadily during the twentieth century due to the expansion of industry and the deliberate development and use of agents of chemical warfare. Although Hong Kong is considered a relatively safe place, hoax anthrax attacks have occurred since 17 October 2001. People who have been seriously injured by hazardous materials have a greater chance of recovery without complications when appropriate emergency treatments are provided. Recognition and identification of hazardous materials, assessment of the conditions, decontamination, and protection of staff and facilities are important elements in the formulation of a contingency plan. The objective of this article is to outline the efforts of the Hong Kong Hospital Authority in formulating a hospital response to incidents involving hazardous materials.