Validation of the RETRIEVE (REverse TRIage EVEnts) Criteria for Same Day Return of Non-ST Elevation Acute Coronary Syndrome Patients to Referring Non-PCI Centres.

BACKGROUND: There are continuing bed constraints in percutaneous coronary intervention centres (PCI) so efficient patient triage from referral hospitals is pivotal. To evaluate a strategy of PCI centre (PCIC) bed-sparing we examined return of patients to referral hospitals screened by the RETRIEVE (REverse TRIage EVEnts) criteria and validated its use as a tool for screening suitability for same day transfer of non-ST-elevation acute coronary syndrome (NSTEACS) patients post PCI to their referring non-PCI centre (NPCIC). METHODS: From May 2008 to May 2011, 433 NSTEACS patients were prospectively screened for suitability for same day transfer back to the referring hospital at the completion of PCI. Of these patients, 212 were excluded from same day transfer using the RETRIEVE criteria and 221 patients met the RETRIEVE criteria and were transferred back to their NPCIC. RESULTS: Over the study period, 218 patients (98.6%) had no major adverse events. The primary endpoint (death, arrhythmia, myocardial infarction, major bleeding event, cerebrovascular accident, major vascular site complication, or requirement for return to the PCIC) was seen in only three transferred patients (1.4%). CONCLUSIONS: The RETRIEVE criteria can be used successfully to identify NSTEACS patients suitable for transfer back to NPCIC following PCI. Same day transfer to a NPCIC using the RETRIEVE criteria was associated with very low rates of major complications or repeat transfer and appears to be as safe as routine overnight observation in a PCIC.

Time to surgery for hip fracture patients in a rural orthopaedic referral hospital.

PROBLEM: It is well established that shorter surgical waiting time for hip fracture patients improves outcomes. We identify and quantify time to surgery for hip fracture patients in a rural hospital. DESIGN: Retrospective observational study. SETTING: : A sixty-bed rural referral hospital with an orthopaedic service. Data were collected for 57 patients 50 years and older who had surgery for Muller AO type 31-A and 31-B fractures at Bega Hospital in 2012. KEY MEASURES FOR IMPROVEMENT: Time to surgery from presentation was compared for patients who presented directly to Bega hospital to those that were transferred from a peripheral hospital. STRATEGIES FOR CHANGE: To quantify contributing factors to surgical delay will help identify areas for future improvement. EFFECTS OF CHANGE: Delay to surgery from presentation was significantly greater for transferred patients (58 hours), compared with direct presentations (41 hours). Mean time for patient transfer was 23 hours. Thirty-five per cent of patients had their operation within 36 hours from presentation. LESSONS LEARNT: The time to surgery for most transfer and direct presentation patients fell outside current guidelines. In our geographically large referral network, delay to surgery was significantly influenced by time to transfer. Based on previously published research, surgery for our hip fracture patients should be expedited. We therefore recommend priority transfer for these significantly injured patients and dedicated emergency operating lists to perform this surgery in a timely manner.