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1.
J Stroke Cerebrovasc Dis ; 29(1): 104477, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31699573

RESUMO

BACKGROUND: A nationally recommended practice to accelerate thrombolytic therapy for acute ischemic stroke is to route emergency medical services (EMS)-transported stroke patients directly to the computed tomography (CT) scanner on arrival. We evaluated door-to-needle time with direct-to-CT routing versus emergency department (ED)-bed first routing. METHODS: This was a retrospective analysis from a large regionalized stroke system. Paramedics utilize the modified Los Angeles Prehospital Stroke Screen and transport acute stroke patients to Approved Stroke Centers. Individual stroke centers postarrival protocols vary, with some routing patients directly to CT. Stroke centers report treatment and outcomes to a registry, from which data were abstracted from May 2015 through April 2016. Adult patients transported by EMS and treated with thrombolytic therapy were included. The primary outcome was door-to-needle time. Secondary outcome was door-to-imaging time. RESULTS: EMS transported 6315 patients for suspected stroke and 789 (13%) were treated with thrombolysis at 41 stroke centers, 171 (22%) at hospitals with direct-to-CT routing and 618 (78%) at hospitals with ED-bed routing. Patient characteristics were similar between groups. Door-to-needle time was not different in the 2 groups, median 57 minutes (interquartile range [IQR] 44-76) for CT routing versus 54 minutes (IQR 40-74) for ED routing, median difference 3 (95% CI -1, 7), P == .2. Door-to-imaging time was shorter with CT routing compared to ED routing, median 13 minutes (IQR 8-21) and 16 minutes (IQR 10-24), respectively. CONCLUSIONS: In this regional stroke system, hospitals with protocols for routing EMS-transported stroke patients directly to CT did not have reduced door-to-needle compared to hospitals without such protocols.


Assuntos
Serviço Hospitalar de Emergência , Fibrinolíticos/administração & dosagem , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica , Tempo para o Tratamento , Tomógrafos Computadorizados , Tomografia Computadorizada por Raios X/instrumentação , Transporte de Pacientes , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Procedimentos Clínicos , Feminino , Humanos , Los Angeles , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sistema de Registros , Estudos Retrospectivos , Fatores de Tempo
2.
J Stroke Cerebrovasc Dis ; 29(1): 104472, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31699574

RESUMO

BACKGROUND: Endovascular mechanical revascularization has become the mainstay acute stroke management secondary to emergent large vessel occlusions. In patients who can benefit from mechanical revascularization, the ability to intervene in a timely manner directly correlates with improved outcomes. The field assessment for stroke triage (FAST-ED) prehospital triage tool, is one of many stroke severity scales designed to decrease time to diagnosis in the field and optimize patient triage to comprehensive stroke centers. It is however unclear what impact if any, this tool has on time to activation of hospital stroke intervention teams. We set out to assess the impact of the implementation of the FAST-ED triage tool on the activation of the stroke intervention team in a community stroke treatment practice. METHODS: We retrospectively reviewed institutional records for consecutive admissions with reported stroke alerts between March 2017 and September 2018, and selected patients who presented via Emergency Medical Services (EMS). The association between FAST-ED scores and impact on time to revascularization as well as the association between FAST-ED scores and the presence of emergent large vessel occlusion were analyzed. RESULTS: There was a statistically significant improvement in interventional team activation times in favor of the FAST-ED cohort, (P < .05). CONCLUSIONS: FAST-ED implementation demonstrates a statistically significant improvement on stroke team activation times for patients who are candidates for mechanical revascularization. Larger cohort analysis is needed to fully evaluate the magnitude of this effect.


Assuntos
Revascularização Cerebral , Serviços Médicos de Emergência , Serviço Hospitalar de Emergência , Procedimentos Endovasculares , Acidente Vascular Cerebral/terapia , Tempo para o Tratamento , Transporte de Pacientes , Triagem , Idoso , Idoso de 80 Anos ou mais , Revascularização Cerebral/efeitos adversos , Revascularização Cerebral/métodos , Técnicas de Apoio para a Decisão , Prestação Integrada de Cuidados de Saúde , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Valor Preditivo dos Testes , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
3.
Anaesthesia ; 75(2): 234-246, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31788789

RESUMO

The location of care for many brain-injured patients has changed since 2012 following the development of major trauma centres. Advances in management of ischaemic stroke have led to the urgent transfer of many more patients. The basis of care has remained largely unchanged, however, with emphasis on maintaining adequate cerebral perfusion as the key to preventing secondary injury. Organisational aspects and training for transfers are highlighted, and we have included an expanded section on paediatric transfers. We have also provided a table with suggested blood pressure parameters for the common types of brain injury but acknowledge that there is little evidence for many of our recommendations. These guidelines remain a mix of evidence-based and consensus-based statements. We have received assistance from many organisations representing clinicians who care for these patients, and we believe our views represent the best of current thinking and opinion. We encourage departments to review their own practice using our suggestions for audit and quality improvement.


Assuntos
Lesões Encefálicas/terapia , Transferência de Pacientes/métodos , Acidente Vascular Cerebral/terapia , Transporte de Pacientes/métodos , Anestesiologia , Anestesistas , Cuidados Críticos , Humanos , Sociedades Médicas
4.
J Surg Res ; 246: 153-159, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31586889

RESUMO

BACKGROUND: Injured children who arrive by self-transport to the emergency department (ED) may receive delayed or inadequate care. We studied differences in demographics, clinical characteristics, and trauma activation status for admitted pediatric trauma patients based on arrival by self-transport or Emergency Medical Services (EMS). MATERIALS AND METHODS: We performed a retrospective cohort study at two level I pediatric trauma centers. INCLUSION CRITERIA: <15 y old with blunt or penetrating injury. We used univariate and multivariate logistic regression analyses to determine associations between trauma activation, ED length of stay (LOS), and hospital LOS with demographic and clinical characteristics. RESULTS: We identified 1161 patients: 40.1% arrived by self-transport and 59.9% by EMS. Self-transport patients were less likely to have an abnormal Glasgow Coma Scale score < 15 (2.1% versus 22.0%, P < 0.001) and Injury Severity Score > 15 (2.4% versus 11.7%, P < 0.001). Trauma activation was initiated in 52.5% of patients, occurring less often in self-transport than EMS patients (2.4% versus 86.2%, P < 0.001). Trauma activation rate was negatively associated with arrival by self-transport (odds ratio [OR] 0.001, 95% CI 0.00-0.003), positively associated with Glasgow Coma Scale <15 (OR 25.9, 95% CI 6.6-101.2) and site (OR 15.4, 95% CI 6.3-37.5) but not with Injury Severity Score >15 (OR 2.8, 95% CI 0.8-9.2). Self-transport arrival was associated with longer ED LOS (estimated regression slope 0.47, 95% CI 0.13-0.82). CONCLUSIONS: Almost half of admitted pediatric trauma patients arrived by self-transport; however, trauma team activation rarely occurs for these patients. Trauma team activation may be underutilized in self-transport patients with injuries resulting in hospital admission.


Assuntos
Transporte de Pacientes/estatística & dados numéricos , Centros de Traumatologia/organização & administração , Triagem/organização & administração , Ferimentos não Penetrantes/diagnóstico , Ferimentos Penetrantes/diagnóstico , Criança , Pré-Escolar , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/normas , Serviço Hospitalar de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços/organização & administração , Utilização de Instalações e Serviços/normas , Utilização de Instalações e Serviços/estatística & dados numéricos , Feminino , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação/estatística & dados numéricos , Masculino , Admissão do Paciente/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Centros de Traumatologia/normas , Centros de Traumatologia/estatística & dados numéricos , Triagem/normas , Triagem/estatística & dados numéricos , Estados Unidos , Ferimentos não Penetrantes/terapia , Ferimentos Penetrantes/terapia
5.
J Trauma Acute Care Surg ; 88(2): 310-313, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31389914

RESUMO

BACKGROUND: There are no reports comparing wounding pattern in urban and public mass shooting events (CPMS). Because CPMS receive greater media coverage, there is a connation that the nature of wounding is more grave than daily urban gun violence. We hypothesize that the mechanism of death following urban gunshot wounds (GSWs) is the same as has been reported following CPMS. METHODS: Autopsy reports of all firearm-related deaths in Washington, DC were reviewed from January 1, 2016, to December 31, 2017. Demographic data, firearm type, number and anatomic location of GSWs, and organ(s) injured were abstracted. The organ injury resulting in death was noted. The results were compared with a previously published study of 19 CPMS events involving 213 victims. RESULTS: One hundred eighty-six urban autopsy reports were reviewed. There were 171 (92%) homicides and 13 (7%) suicides. Handguns were implicated in 180 (97%) events. One hundred eight (59%) gunshots were to the chest/upper back, 85 (46%) to the head, 77 (42%) to an extremity, and 71 (38%) to the abdomen/lower back. The leading mechanisms of death in both urban firearm violence and CPMS were injury to the brain, lung parenchyma, and heart. Fatal brain injury was more common in CPMS events as compared with urban events involving a handgun. CONCLUSION: There is little difference in wounding pattern between urban and CPMS firearm events. Based on the organs injured, rapid point of wounding care and transport to a trauma center remain the best options for mitigating death following all GSW events. LEVEL OF EVIDENCE: Epidemiological, level IV.


Assuntos
Lesões Encefálicas/mortalidade , Traumatismos Cardíacos/mortalidade , Lesão Pulmonar/mortalidade , Incidentes com Feridos em Massa/estatística & dados numéricos , Ferimentos por Arma de Fogo/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas/etiologia , Lesões Encefálicas/terapia , Causas de Morte , District of Columbia/epidemiologia , Feminino , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/terapia , Humanos , Lesão Pulmonar/etiologia , Lesão Pulmonar/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Transporte de Pacientes/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos , Ferimentos por Arma de Fogo/etiologia , Ferimentos por Arma de Fogo/terapia , Adulto Jovem
6.
Anaesthesia ; 75(3): 353-358, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31828768

RESUMO

In our previous study, a Paediatric Early Warning Score could be calculated for only one-fifth of 102,993 children transported by ambulance to hospital, as components other than supplemental oxygen were not reliably measured: respiratory rate 90,358 (88%); Glasgow Coma Score 83,648 (81%); heart rate 83,330 (81%); time to capillary reperfusion 81,685 (79%); oxygen saturation 71,372 (69%); temperature 60,402 (59%); systolic blood pressure 37,088 (36%). We tested 12 abbreviated scores with 3-5 components. The discrimination of these 12 scores for the primary outcome (30-day mortality or admission to paediatric intensive care), as measured by the area under the receiving operator characteristic curve, ranged from 0.69 to 0.80. Scores could be calculated for at most 74,508 (72%) children when heart rate, conscious level and respiratory rate were measured, with or without supplemental oxygen: the discrimination of these two versions was 0.75 and 0.77, respectively. Optimal threshold scores of 3 and 2 for these two abbreviated versions discriminated an outcome rate of 2-3% in about one third of children from the other children who had < 1% rate of outcome.


Assuntos
Serviços Médicos de Emergência/métodos , Adolescente , Criança , Pré-Escolar , Transtornos da Consciência/diagnóstico , Cuidados Críticos , Feminino , Escala de Coma de Glasgow , Frequência Cardíaca , Humanos , Lactente , Masculino , Oxigênio/uso terapêutico , Curva ROC , Reprodutibilidade dos Testes , Taxa Respiratória , Escócia , Transporte de Pacientes , Resultado do Tratamento
7.
Ann Vasc Surg ; 62: 119-127, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31476424

RESUMO

BACKGROUND: By necessity, wartime arterial injuries undergo staged management. Initial procedures may occur at a forward surgical team (role 2), where temporary shunts can be placed before transfer to a larger field hospital (role 3) for definitive reconstruction. Our objective was to evaluate the impact of staging femoropopliteal injury care on limb outcomes. METHODS: A military vascular injury database was queried for Iraq/Afghanistan casualties with femoropopliteal arterial injuries undergoing attempted reconstruction (2004-2012). Cases were grouped by initial arterial management: shunt placed at role 2 (R2SHUNT), reconstruction at role 2 (R2RECON), and initial management at role 3 (R3MGT). The primary outcome was limb salvage; secondary outcomes were limb-specific complications. Descriptive and intergroup comparative statistics were performed with significance defined at P ≤ 0.05. RESULTS: Of 257 cases, all but 4 had definitive reconstruction before evacuation to Germany (median, 2 days): 46 R2SHUNT, 84 R2RECON, and 127 R3MGT; median Mangled Extremity Severity Score was 6 for all groups. R2SHUNT had median extremity Abbreviated Injury Scale--vascular of 4 (other groups, 3; P < 0.05) and was more likely to have concomitant venous injury and to undergo fasciotomy. Shunts were used for 5 ± 3 hr. About 24% of R2RECON repairs were revised at role 3. Limb salvage rate of 80% was similar between groups, and 62% of amputations performed within 48 hr of injury. Rates of limb and composite graft complications were similar between groups. Thrombosis was more common in R2SHUNT (22%) than R2RECONST (6%) or R3MGT (12%) (P = 0.03). Late (>48 hr) thrombosis rates were similar, whereas 60% of R2SHUNT thromboses occurred on day of injury (P = 0.003 vs. 25% and 0%). CONCLUSIONS: Staged femoropopliteal injury care is associated with similar limb salvage to initial role 3 management. Early thrombosis is likely because of shunt failure but does not lead to limb loss. Current military practice guidelines are appropriate and may inform civilian vascular injury management protocols.


Assuntos
Artéria Femoral/cirurgia , Artéria Poplítea/cirurgia , Procedimentos Cirúrgicos Vasculares , Lesões do Sistema Vascular/cirurgia , Campanha Afegã de 2001- , Amputação , Bases de Dados Factuais , Artéria Femoral/lesões , Humanos , Iraque , Salvamento de Membro , Medicina Militar , Militares , Artéria Poplítea/lesões , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Transporte de Pacientes , Resultado do Tratamento , Estados Unidos , Procedimentos Cirúrgicos Vasculares/efeitos adversos
8.
J Law Med ; 26(4): 742-749, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31682354

RESUMO

This article updates how Australia's national security concerns have intersected with the regulation of Australian medical practitioners in the area of mandatory, indefinite, administrative offshore detention of asylum-seekers. It outlines relevant recent decisions of the High Court, including dissenting opinions that such detention represents unconstitutional extra-judicial punishment with a primary deterrence aim. It evaluates recent amendments to the Australian Border Force Act 2015 (Cth) as well as exploring recent relevant legislation and administrative, political and judicial decisions made in both Papua New Guinea and the Republic of Nauru. It considers the Medical Evacuation legislation and the Australian Government's attempts to challenge judicial authority to transfer people off Nauru for medical treatment. The article concludes with an analysis of prospects for further Australian asylum seeker and refugee policy and legislative reform more coherent with basic principles of medical ethics and international human rights.


Assuntos
Pessoal de Saúde , Refugiados , Transporte de Pacientes/legislação & jurisprudência , Austrália , Humanos , Punição , Medidas de Segurança
9.
Adv Clin Exp Med ; 28(11): 1495-1505, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31778597

RESUMO

BACKGROUND: Patients with acute myocardial infarction (AMI) or acute trauma (AT) are transported by air to save time. Helicopter Emergency Medical Service (HEMS) provides both flights to and from the emergency scene, as well as interhospital transport (interHtransport). OBJECTIVES: The objective of this study was to compare aeromedical transport and HEMS missions of AMI and AT patients regarding safety, medical procedures and the length of flights. MATERIAL AND METHODS: This is a case-control study analyzing the medical history records of AMI and AT patients transported between hospitals and from the scene identified using ICD-10 codes. Research of customary data (age, sex and general health status measured with Glasgow Coma Scale (GCS) and Revised Trauma Score (RTS)) was performed. RESULTS: There were 48,555 flights in the years 2011-2016, of which 7,645 (15.7%) were interhospital (19% AMI and 12% AT). Out of these, 40,910 (84.3%) HEMS missions were to patients on the scene (10% AMI and 13% AT). No fatalities were noted. The AMI GCS score was higher than in AT patients: 15.0 vs 14.0, respectively. The medical procedures during transport of AMI patients between hospitals and from the scene were the following: cardiopulmonary resuscitation (CPR): 6 vs 73 cases (p < 0.001); oxygen therapy: 41.1% vs 50.2%, respectively. The median distance was 59.4 km vs 52.1 km (p < 0.001), while median flight time was 45.0 min vs 38.0 min (p < 0.001), respectively. Regarding AT patients, the procedures performed (during interhospital and from the scene transport) were the following: CPR: 5 vs 244 cases (p < 0.001); intubation: 10.7% vs 17.3% (p < 0.001); sedation: 50.1% vs 24.3% (p < 0.001); oxygen therapy: 17.6% vs 36.6% (p < 0.001); spinal board: 17.1% vs 66% (p < 0.001); cervical collar: 15.9% vs 63.4% (p < 0.001), respectively. Interhospital transport and HEMS mission median flight distance was 135.9 km vs 56.3 km (p < 0.001), while median flight time was 66.0 min vs 45.0 min (p < 0.001), respectively. CONCLUSIONS: Aeromedical transport is safe and very rarely requires resuscitation during the flight. The long distances of flights and time required can reflect the scarcity of trauma centers (TCs) compared to cardiovascular wards. The location of hemodynamic centers in Poland is optimal.


Assuntos
Resgate Aéreo , Serviços Médicos de Emergência , Infarto do Miocárdio , Transporte de Pacientes/métodos , Estudos de Casos e Controles , Serviços Médicos de Emergência/estatística & dados numéricos , Humanos , Infarto do Miocárdio/terapia , Polônia , Estudos Retrospectivos , Fatores de Tempo
10.
Presse Med ; 48(11 Pt 1): e293-e306, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31734050

RESUMO

BACKGROUND: Little is known regarding healthcare for cancer patients treated mainly at home during the month before they die. The aim of this study was to provide information on how they were treated and what were their causes of death. METHODS: This population-based observational study analysing information obtained from the French national healthcare data system (SNDS) included adult health insurance beneficiaries treated for cancer who died in 2015 after having spent at least 25 of their last 30 days at home. RESULTS: Among the cancer patients who died in 2015, 25,463 (20%) were included [mean age (±SD) 74±13.2 years, men 62%]; 54% of them died at home. They were slightly older (75 vs. 73 years) than those who died in hospital, had less frequently received hospital palliative care during the year preceding their deaths (19% vs. 41%) and had less often used medical transport (41% vs. 73%) to an emergency department (8% vs. 62%), to hospital-based (11% vs. 17%) or community-based (16% vs. 12%) chemotherapy, to a general practitioner (73% vs. 78%) or to a community-based nursing service (63% vs. 73%). However, when they consulted a general practitioner (median 3 visits vs. 2) or a nurse (median 22 nursing procedures vs. 10) during their last month of life, visits were more frequent. The leading cause of death was tumour, which represented 69% of deaths at home vs. 74% of deaths in hospital. CONCLUSIONS: In France, home management during the last month of life is uncommon and even when it is occurs, in one out of two cases patients pass away in a hospital setting. This study is an interrogation on medical choices, given the wish of many of the French to die at home and placing their choices in an international perspective.


Assuntos
Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Assistência Domiciliar , Neoplasias/mortalidade , Neoplasias/terapia , Assistência Terminal , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Comorbidade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , França , Medicina Geral/estatística & dados numéricos , Assistência Domiciliar/estatística & dados numéricos , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Serviços de Enfermagem/estatística & dados numéricos , Cuidados Paliativos/estatística & dados numéricos , Estudos Retrospectivos , Distribuição por Sexo , Fatores de Tempo , Transporte de Pacientes/estatística & dados numéricos
11.
Medicine (Baltimore) ; 98(39): e17330, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574869

RESUMO

The aim of this study was to investigate the experiences of medical transportation of Korean travelers who suffered accidents abroad and then transferred home by our aeromedical team.We collected demographic and clinical data on patients injured while traveling abroad from January 2013 to July 2017. Descriptive analyses based on 4 different transportation methods and transport time since hospitalization were performed.A total of 33 patients were repatriated during the study period. Of these, 28 (84.8%) were trauma cases with pedestrian injuries being the most common (11 cases; 39.3%). Twenty patients were repatriated by flight-stretchers, 6 by flight-prestige, 2 by ship, and 5 by air ambulance. The air ambulance was the most expensive (average 61,124 US Dollars) mode of transportation (P = .001) and the ship took the longest time (14 hours) to transport patients back to Korea from regions with similar distance (P = .0023).We experienced medical repatriation of 33 seriously injured Korean travelers back to South Korea. Transfer time should be an important considering factor and directly contacting and communicating with the specialized staff of foreign hospitals could also be very important to reduce unnecessary overseas hospital stay and cost incidence.


Assuntos
Transporte de Pacientes , Viagem/estatística & dados numéricos , Ferimentos e Lesões , Acidentes/economia , Acidentes/estatística & dados numéricos , Adulto , Resgate Aéreo , Feminino , Humanos , Incidência , Seguro Saúde , Internacionalidade , Masculino , República da Coreia , Macas (Leitos) , Transporte de Pacientes/economia , Transporte de Pacientes/métodos , Transporte de Pacientes/estatística & dados numéricos , Ferimentos e Lesões/economia , Ferimentos e Lesões/epidemiologia
12.
BMC Med ; 17(1): 184, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31570106

RESUMO

BACKGROUND: The healthcare system can be understood as the dynamic result of the interaction of hospitals, patients, providers, and government configuring a complex network of reciprocal influences. In order to better understand such a complex system, the analysis must include characteristics that are feasible to be studied in order to redesign its functioning. The analysis of the emergent patterns of pregnant women flows crossing municipal borders for birth-related hospitalizations in a region of São Paulo, Brazil, allowed to examine the functionality of the regional division in the state using a complex systems approach and to propose answers to the dilemma of concentration vs. distribution of maternal care regional services in the context of the Brazilian Unified Health System (SUS). METHODS: Cross-sectional research of the areas of influence of hospitals using spatial interaction methods, recording the points of origin and destination of the patients and exploring the emergent patterns of displacement. RESULTS: The resulting functional region is broader than the limits established in the legal provisions, verifying that 85% of patients move to hospitals with high technology to perform normal deliveries and cesarean sections. The region has high independence rates and behaves as a "service exporter." Patients going to centrally located hospitals travel twice as long as patients who receive care in other municipalities even when the patients' conditions do not demand technologically sophisticated services. The effects of regulation and the agents' preferences reinforce the tendency to refer patients to centrally located hospitals. CONCLUSIONS: Displacement of patients during delivery may affect indicators of maternal and perinatal health. The emergent pattern of movements allowed examining the contradiction between wider deployments of services versus concentration of highly specialized resources in a few places. The study shows the potential of this type of analysis applied to other type of patients' flows, such as cancer or specialized surgery, as tools to guide the regionalization of the Brazilian Health System.


Assuntos
Procedimentos Clínicos/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Adulto , Brasil/epidemiologia , Cesárea/estatística & dados numéricos , Cidades/epidemiologia , Cidades/estatística & dados numéricos , Procedimentos Clínicos/organização & administração , Procedimentos Clínicos/normas , Estudos Transversais , Assistência à Saúde/organização & administração , Assistência à Saúde/normas , Parto Obstétrico/métodos , Parto Obstétrico/normas , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Serviços de Saúde Materna/organização & administração , Serviços de Saúde Materna/normas , Transferência de Pacientes/organização & administração , Gravidez , Indicadores de Qualidade em Assistência à Saúde , Encaminhamento e Consulta/estatística & dados numéricos , Análise de Sistemas , Transporte de Pacientes/estatística & dados numéricos
13.
Tidsskr Nor Laegeforen ; 139(12)2019 09 10.
Artigo em Inglês, Norueguês | MEDLINE | ID: mdl-31502796

RESUMO

BACKGROUND: It is a policy objective to increase the percentage of journeys made by bicycle in Norway from the current 5 % to 10 %. Kristiansand is one of the most active cities in Norway in terms of cycling. We wished to identify the extent of injuries among cyclists admitted to the hospital. MATERIAL AND METHOD: We reviewed the medical records of patients with cycling-related injuries who were admitted to Sørlandet Hospital, Kristiansand in the period 1 January 2012 to 31 December 2015. Patient, accident, injury and treatment characteristics were recorded, as well as any sequelae after 12 months. RESULTS: Altogether 224 adults and 53 children (<16 years) were registered with cycling-related injuries, most of which (n=192, 69 %) were mild/moderate. Very severe and critical injuries were recorded in 6 (11 %) children and 22 (10 %) adults. Fractures (n=179, 65 %) and minor head injuries (n= 78, 28 %) dominated the injury panorama. Surgical treatment was undertaken in 107 (48 %) adults and 19 (36 %) children. A total of 12 (4 %) patients were transferred to the trauma centre at Oslo University Hospital Ullevål. Four adults had significant sequelae after 12 months, all related to severe head/neck injury. INTERPRETATION: A considerable proportion of serious and complex injuries require that the national guidelines for use of a trauma team be followed. Systematic and ongoing registration of cyclists' injuries in the form of a national registry could help increase our insight into the circumstances surrounding accidents and the extent of injuries related to these.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Ciclismo/lesões , Adolescente , Adulto , Ciclismo/estatística & dados numéricos , Criança , Traumatismos Craniocerebrais/epidemiologia , Serviços Médicos de Emergência , Feminino , Fraturas Ósseas/epidemiologia , Humanos , Tempo de Internação , Masculino , Registros Médicos , Pessoa de Meia-Idade , Noruega/epidemiologia , Estações do Ano , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Fatores de Tempo , Transporte de Pacientes , Índices de Gravidade do Trauma
14.
Int Heart J ; 60(5): 1219-1221, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484873

RESUMO

We recently experienced a 43-year-old man with dilated cardiomyopathy transported under the Impella support to a high-volume left ventricular assist device (LVAD) center. Stabilized hemodynamics with the Impella and firm fixation of the device were important for safe transportation of the patient.


Assuntos
Cardiomiopatia Dilatada/cirurgia , Coração Auxiliar , Segurança do Paciente , Adulto , Cardiomiopatia Dilatada/diagnóstico , Humanos , Japão , Masculino , Monitorização Fisiológica/métodos , Medição de Risco , Transporte de Pacientes/métodos
15.
J Stroke Cerebrovasc Dis ; 28(11): 104368, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31537417

RESUMO

INTRODUCTION: Little is known about the effectiveness of endovascular treatment (EVT) in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) admitted to a primary stroke center (PSC). The aim of this study was to assess EVT effectiveness after transfer from a PSC to a distant (156 km apart; 1.5 hour by car) comprehensive stroke center (CSC), and to discuss perspectives to improve access to EVT, if indicated. PATIENTS AND METHOD: Analysis of the data collected in a 6-year prospective registry of patients admitted to a PSC for AIS due to LVO and selected for transfer to a distant CSC for EVT. The rate of transfer, futile transfer, EVT, reperfusion (thrombolysis in cerebral infarction score ≥2b-3), and relevant time measures were determined. RESULTS: Among the 529 patients eligible, 278 (52.6%) were transferred and 153 received EVT (55% of transferred patients) followed by reperfusion in 115 (overall reperfusion rate: 21.7%). Median times (interquartile range) were: 90 minutes (76-110) for PSC-door-in to PSC-door-out, 88 minutes (65-104) for PSC-door-out to CSC-door-in, 262 minutes (239-316) for PSC-imaging to reperfusion, and 393 minutes (332-454) for symptom onset to reperfusion. At 3 months, rates of favorable outcome (modified Rankin Scale 0-2) were not significantly different between patients eligible for EVT (42.4%), transferred patients (49.1%) and patients who underwent EVT (34.1%). DISCUSSION AND CONCLUSIONS: Our study suggests that transfer to a distant CSC is associated with reduced access to early EVT. These results argue in favor of on-site EVT at high volume PSCs that are distant from the CSC.


Assuntos
Assistência Integral à Saúde , Procedimentos Endovasculares , Acesso aos Serviços de Saúde , Regionalização , Acidente Vascular Cerebral/terapia , Tempo para o Tratamento , Transporte de Pacientes , Idoso , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recuperação de Função Fisiológica , Sistema de Registros , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
17.
Stud Health Technol Inform ; 264: 1847-1848, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438373

RESUMO

In Taiwan, the safety of intra-hospital patient transportation (IHT) is an important issue of patient safety. However, the effects on the quality of patient transportation and the results of patient safety in applying informatics and communication technology were less discussed. The purpose of this study is aimed to understand the current status of IHT events through the patient transportation management system as a reference for further improving the IHT quality.


Assuntos
Tecnologia da Informação , Transporte de Pacientes , Hospitais , Humanos , Segurança do Paciente , Taiwan , Transportes
18.
Surgery ; 166(4): 587-592, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31447104

RESUMO

BACKGROUND: Our regional trauma organization, which comprises 7 trauma centers, 30 acute care hospitals and free-standing emergency departments, and 42 emergency medical services agencies, conducted possibly the largest mass-casualty drill to date, totaling 445 victims at 3 sites involving 11 hospitals and 25 agencies and organizations. METHODS: The drill was preceded by a tabletop exercise 4 months beforehand called Operation Continued Care Full-Scale Exercise, which consisted of simulated terrorist events at 3 sites to wound 445 moulaged patients. Four law enforcement and 5 fire and emergency medical services departments and 16 supporting organizations and agencies were involved in transporting patients to 11 different hospitals. The 7 objectives for the event addressed coordinating emergency operations, sustaining adequate communications, updating regional bed status, processing resource requests, triaging patients, tracking patients, and patient identification. RESULTS: Of the 445 transported patients, 270 (60%) were entered correctly into the state patient tracking system; 68 (25.2%) upgrades and 34 (12.6%) downgrades from scene triage categories were noted. Multiple opportunities for improvement were identified, with major weaknesses noted in communication and coordination from event sites to the regional trauma organizations and hospitals. CONCLUSION: The size and complexity of the drill provided experience and knowledge to facilitate future disaster preparedness and highlighted weaknesses in communication and coordination. Large, multijurisdictional, multiagency exercises provide opportunities to stress, evaluate, and improve regional disaster preparedness.


Assuntos
Defesa Civil/organização & administração , Planejamento em Desastres/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Incidentes com Feridos em Massa/mortalidade , Transporte de Pacientes/organização & administração , Centros de Traumatologia/organização & administração , Feminino , Bombeiros/estatística & dados numéricos , Humanos , Comunicação Interdisciplinar , Masculino , Incidentes com Feridos em Massa/prevenção & controle , Inovação Organizacional , Controle de Qualidade , Triagem , Estados Unidos
19.
Anesth Analg ; 129(3): 671-678, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31425206

RESUMO

BACKGROUND: We implemented a new policy at our institution where the responsibility for intensive care unit (ICU) patient transports to the operating room (OR) was changed from the anesthesia to the ICU service. We hypothesized that this approach would be associated with increased on-time starts and decreased turnover times. METHODS: In the historical model, intubated patients or those on mechanical circulatory assistance (MCA) were transported by the anesthesia service to the OR ("pre-ICU Pickup"). In our new model, these patients are transported by the ICU service to the preoperative holding area (Pre-op) where care is transferred to the anesthesia service ("post-ICU Transfer"). If judged necessary by the ICU or anesthesia attending, the patient was transported by the anesthesia service ("post-ICU Pickup"). We retrospectively reviewed case tracking data for patients undergoing surgery before (January 2014 to May 2015) and after implementation (July 2016 to June 2017) of the new policy. The primary outcome was the proportion of elective, weekday first-case, on-time starts. To adjust for confounders including comorbidities and time trends, we performed a segmented logistic regression analysis assessing the effect of our intervention on the primary outcome. Secondary outcomes were turnover times and compliance with preoperative checklist documentation. RESULTS: We identified 95 first-start and 86 turnover cases in the pre-ICU Pickup, 70 first-start and 88 turnover cases in the post-ICU Transfer, and 6 turnover cases in the post-ICU Pickup group. Ignoring time trends, the crude proportion of on-time starts increased from 32.6% in the pre-ICU Pickup to 77.1% in the post-ICU Transfer group. After segmented logistic regression adjusting for age, sex, American Society of Anesthesiologists (ASA) physical status, Sequential Organ Failure Assessment (SOFA) score, respiratory failure, endotracheal intubation, MCA, congestive heart failure (CHF), valvular heart disease, and cardiogenic and hemorrhagic shock, the post-ICU Transfer group was more likely to have an on-time start at the start of the intervention than the pre-ICU Pickup group at the end of the preintervention period (odds ratio, 11.1; 95% confidence interval [CI], 1.3-125.7; P = .043). After segmented linear regression adjusting for the above confounders, the estimated difference in mean turnover times between the post-ICU Pickup and pre-ICU Transfer group was not significant (-6.9 minutes; 95% CI, -17.09 to 3.27; P = .17). In post-ICU Transfer patients, consent, history and physical examination (H&P), and site marking were verified before leaving the ICU in 92.9%, 93.2%, and 89.2% of the cases, respectively. No adverse events were reported during the study period. CONCLUSIONS: A transition from the anesthesia to the ICU service for transporting ICU patients to the OR did not change turnover times but resulted in more on-time starts and high compliance with preoperative checklist documentation.


Assuntos
Serviço Hospitalar de Anestesia/normas , Estado Terminal/terapia , Unidades de Terapia Intensiva/normas , Transporte de Pacientes/normas , Fluxo de Trabalho , Adulto , Idoso , Serviço Hospitalar de Anestesia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transporte de Pacientes/métodos
20.
J Clin Neurosci ; 70: 151-156, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31439489

RESUMO

BACKGROUND: Providing thrombectomy services to rural or remote regions with small, dispersed populations presents a particular challenge. Sustaining local thrombectomy services is not viable given the low throughput of cases, therefore large vessel occlusion (LVO) stroke patients require emergent transfer, often by air, to the closest high volume urban thrombectomy unit. The aim of this paper is to present logistical, time-metric data and outcome data on LVO stroke patients that have been aeromedically retrieved for thrombectomy from the vast, 2,500,000-km2 rural catchment of the Western Australian state thrombectomy unit. METHODS: The prospectively collected state thrombectomy registry was reviewed and all patients that underwent thrombectomy for LVO strokes following aeromedical retrieval from remote or rural catchments were identified. Multiple logistic and time-metric data points were recorded and outcomes were compared to a cohort of urban patients treated over the same period. RESULTS: Over a 2-year period 30 patients underwent thrombectomy following aeromedical retrieval, either by helicopter or fixed wing aircraft, from rural and remote regions of Western Australia. The mean aeromedical retrieval distance was 393 km while the maximum retrieval distance was over 2600 km. The mean ictus to recanalization time was 657 min, an mTICI 2b-3 recanalization was achieved in 93% of cases and 62% of anterior circulation, and 50% of posterior circulation LVO stroke patients achieved functional independence at 90-days. Outcome data for rural patients compared favourably to urban patients treated over the same time period. CONCLUSION: With the availability of an efficient aeromedical retrieval service, LVO stroke patients in rural and remote regions can achieve excellent outcomes following transfer to a high volume thrombectomy unit, even if distances involved are very large.


Assuntos
Transferência de Pacientes/métodos , Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos , Transporte de Pacientes/métodos , Idoso , Viagem Aérea , Austrália , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , População Rural , Resultado do Tratamento
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