INTER-HOSPITAL TRANSFER OF TRAUMA PATIENTS IN A DEVELOPING COUNTRY: A PROSPECTIVE DESCRIPTIVE STUDY

Introduction: During interhospital transfer patients are at risk due to possibility of serious complications. There are no guidelines governing the transfer of injured patients in India. It is important to identify the extent of the problem in the transfer process of the injured transferred to the trauma centre.Methods: On arrival in the Emergency Department patients were assessed for clinical status and the Glasgow Coma Score (GCS). The transfer vehicle was evaluated and the accompanying transfer personnel was interviewed to record details of the transfer process, training of the transfer personnel, adequacy of the transfer vehicle and its outfitted monitoring equipment. Data communicated to the trauma centre from the referring hospitals were also collected from the transfer records. The transferred group was compared to the non-transferred group.Results: Of the 592 patients admitted, 572 consented to the study. 327 were referred patients and 245 were directly admitted patients. Patients referred from peripheral hospitals had significantly lower GCS, higher ISS, higher admission gap and longer duration of hospital stay. The date and time of injury was documented in none of the referred patients, referral time in 44 (13.71%) cases, pulse rate in 110(34.38%) patients, blood pressure in 112 (34.25%) cases. The request for transfer was made in only 3 (0.93%) cases. Twelve cases (3.66%) were accompanied by a paramedic or a nurse. Intravenous access and infusions in progress were present in 192/327 (58.71%) transferred patients. Urethral catheters were present in 49 (15.17%) patients. Only 9/327 (2.79%) transferred patients had hard cervical immobilization. Hypotension at admission defined as a systolic BP < 120mm of Hg was present in 106 referred admitted cases. Conclusion: This study suggests that the injured patients are not being transferred in a manner that is consistent with evidence based guidelines which are known to minimize the known hazards of transfer process and consequently improve outcome. Despite the efforts being made, the condition as of now is unacceptable and needs a rational referral policy contributed to and agreed by all service providers which must be strongly enforced without delay

Defining measures of emergency care access in low-income and middle-income countries: a scoping review

Background Over 50% of annual deaths in low-income and middle-income countries (LMICs) could be averted through access to high-quality emergency care.Objectives We performed a scoping review of the literature that described at least one measure of emergency care access in LMICs in order to understand relevant barriers to emergency care systems.Eligibility criteria English language studies published between 1 January 1990 and 30 December 2020, with one or more discrete measure(s) of access to emergency health services in LMICs described.Source of evidence PubMed, Embase, Web of Science, CINAHL and the grey literature.Charting methods A structured data extraction tool was used to identify and classify the number of ‘unique’ measures, and the number of times each unique measure was studied in the literature (‘total’ measures). Measures of access were categorised by access type, defined by Thomas and Penchansky, with further categorisation according to the ‘Three Delay’ model of seeking, reaching and receiving care, and the WHO’s Emergency Care Systems Framework (ECSF).Results A total of 3103 articles were screened. 75 met full study inclusion. Articles were uniformly descriptive (n=75, 100%). 137 discrete measures of access were reported. Unique measures of accommodation (n=42, 30.7%) and availability (n=40, 29.2%) were most common. Measures of seeking, reaching and receiving care were 22 (16.0%), 46 (33.6%) and 69 (50.4%), respectively. According to the ECSF slightly more measures focused on prehospital care—inclusive of care at the scene and through transport to a facility (n=76, 55.4%) as compared with facility-based care (n=57, 41.6%).Conclusions Numerous measures of emergency care access are described in the literature, but many measures are overaddressed. Development of a core set of access measures with associated minimum standards are necessary to aid in ensuring universal access to high-quality emergency care in all settings