Hastane içi alandan çocuk acil servise yapılan hasta nakilleri

Amaç: Bu çalışmanın amacı hastane içi alanlardan çocuk acil servise (ÇAS) “ters nakil” ile sevk edilen olguların klinik özelliklerini, aciliyetlerini ve nakil nedenlerini belirlemek ve hazırlanacak hastane içi nakil protokollerine katkıda bulunmaktır. Gereç ve Yöntem: Bu çalışma retrospektif kohort çalışmasıdır. Hastane içinde, acil servis dışında muayene edilen ve ÇAS’a nakledilen 120 hastanın klinik özellikleri değerlendirildi. Bulgular: Hastaların %57,5'i (69) erkek olup, ortanca yaş 42 (0-210) ay idi. %45.8'i (55) klinik durumları acil tedavi gerektirdiği için ÇAS’a sevk edilmişti. Bu hastaların %54,8'i Pediatrik Değerlendirme Üçgenine (PDÜ) göre stabil ve %78,6'sı Acil Şiddet İndeksi'ne (ESI) göre kategori 3, 4, 5 idi. Sadece dört hastaya ESI hayat kurtarıcı prosedürler uygulanmıştı. %70'i (84) acil serviste tedavi edildi. ÇAS’a nakil nedenleri ile PDÜ ve ESI triyaj kategorileri arasında istatistiksel bir anlamlılık vardı. Sonuç: ÇAS’e hastane içindeki diğer servisrlerden gönderilen hastaların büyük kısmı stabil hastalardır. Acil servisin etkin kullanımı için acil servise nakledilecek hastaların ilgili hekim tarafından titizlikle değerlendirilmesi, hemodinamik olarak stabil olmayan hastaların acil servise nakline öncelik verilmeli ve kısa süreli takip veya tedavi ünitelerinde uygun bir şekilde tedavi edilmelidir. Stabil hastalar için her hastanenin imkanları doğrultusunda acil servisten bağımsız bir alan oluşturulmalıdır.

Anahtar Kelimeler:

Çocuk, acil, hastane içi nakil, nakil

In-hospital pediatric patient transfers to the pediatric emergency department

Purpose: The aim of this study was to determine whether the clinical features of the cases referred from in-hospital areas to the pediatric emergency department (ED) with “reverse transport” have emergency characteristics and the reasons for the transfer, and to contribute to intra-hospital transfer protocols to be prepared. Materials and Methods: This is a retrospective cohort study. The clinical properties of 120 patients who were sent to the ED from the hospital area were evaluated. Results: 57.5% (69) of the patients were male and the median age was 42 months (0-210 months). 45.8% (55) were referred to the ED because their clinical condition required emergency treatment. 54.8% of these patients were stable according to Pediatric Assessment Triangle (PAT) and 78.6% were category 3, 4, 5 according to Emergency Severity Index (ESI). Only 4 patients received ESI life-saving procedures. 70% (84) were treated in the ED. There was a statistically significant difference between the PAT and ESI and the group of patients whose clinical status needed urgent treatment. Conclusion: Most of the patients sent to PED from other wards within the hospital are stable patients. For the effective use of the PED, the patients who will be transferred to the PED should be carefully evaluated by the relevant physician, priority should be given to the transport of hemodynamically unstable patients to the emergency room, and they should be treated appropriately in short-term follow-up or treatment units. For stable patients, an area independent from the emergency department should be created in line with the facilities of each hospital.

Keywords:

Children, emergency, intra-hospital transport, transport,

PDF

___

1. Sethi D, Subramanian S. When place and time matter: how to conduct safe inter-hospital transfer of patients. Saudi J Anaesth. 2014;8:104-13.
2. Warren J, Fromm Jr RE, Orr RA, Rotello LC, Horst HM, American College of Critical Care Medicine. Guidelines for the inter-and intrahospital transport of critically ill patients. Crit Care Med. 2004;32:256-62.
3. Jarden RJ, Quirke S. Improving safety and documentation in intrahospital transport: development of an intrahospital transport tool for critically ill patients. Intensive Crit Care Nurs. 2010;26:101-7.
4. Veiga VC, Postalli NF , Alvarisa TK, Travassos PP, da Silva Vale RT, de Oliveira CZ et al. Adverse events during intra-hospital transport of critically ill patients in a large hospital. Rev Bras Ter Intensiva. 2019;31:15- 20.
5. Williams P, Karuppiah S, Greentree K, Darvall J. A checklist for intra-hospital transport of critically ill patients improves compliance with transportation safety guidelines. Aust Crit Care. 2020;33:20-4.
6. Dieckmann RA, Brownstein D, Gausche-Hill M. The pediatric assessment triangle: A novel approach for the rapid evaluation of children. Pediatr Emerg Care. 2010;26:312-5.
7. Horeczko T, Enriquez B, McGrath NE, Gausche-Hill M, Lewis RJ. The pediatric assessment triangle: accuracy of its application by nurses in the triage of children. J Emerg Nurs. 2013;39:182-9.
8. Fernandez A, Benito J, Mintegi S. Is this child sick? Usefulness of the Pediatric Assessment Triangle in emergency settings. J Pediatr (Rio J). 2017;93:60-7.
9. Eitel DR, Travers DA, Rosenau A, Gilboy N, Wuerz RC. The emergency severity index version 2 is reliable and valid. Acad Emerg Med. 2003;10:1079-80.
10. Tanabe P, Gimbel R, Yarnold PR, Adams J. The Emergency Severity Index (v.3) five level triage systemscores predict ED resource consumption. J Emerg Nurs. 2004;30:22-9.
11. Gilboy N, Tanabe P, Travers D, Rosenau AM, Eitel DR. Emergency Severity Index (ESI) version 4. Implementation Handbook. Rockville, MD, Agency for Healthcare Research and Quality. 2005.
12. Conners GP, Melzer SM, Committee on Hospital Care. Pediatric observation units. Pediatrics. 2012;130:172-9..
13. Choi HK, Shin SD, Ro YS, Kim DK, Shin SH, Kwak YH. A before- and after-intervention trial for reducing unexpected events during the intrahospital transport of emergency patients. Am J Emerg Med. 2012;30:1433-40.
14. Kue R, Brown P, Ness C, Scheulen J. Adverse clinical events during intra-hospital transport by a specialized team: a preliminary report. Am J Crit Care. 2011;20:153-61.
15. Weiner D, Deanehan K. Chapter 66. Respiratory distress. In Textbook of Pediatric Emergency Medicine. 7th eds. (Eds KN Shaw, RG Bachur):451- 64. Baltimore, Lippincott Williams &Wilkins, 2016.
16. Scribano PV, Wiley JF, Platt K. Use of an observation unit by a pediatric emergency department for common pediatric illnesses. Pediatr Emerg Care. 2001;17:321-3.