Waiting for definitive care: An analysis of elapsed time from decision to surgery or transfer in a rural centre

Autor:	Manivannan Sathveegarajah, Weranja Ranasinghe, Matthew K. H. Hong, Francis J. Miller, Hannah Dobson, Liliana N. Bray, Fatima Vally
Rok vydání:	2015
Předmět:	medicine.medical_specialty education.field_of_study business.industry Population Public Health Environmental and Occupational Health Retrospective cohort study Emergency department Surgery Interquartile range Transfer (computing) Referral centre Emergency medicine medicine Family Practice education business Patient transfer Surgical patients
Zdroj:	Australian Journal of Rural Health. 23:155-160
ISSN:	1038-5282
DOI:	10.1111/ajr.12160
Popis:	Objective To examine the timing of operative management and interhospital transfer of emergency general surgical patients in a regional setting. Design Retrospective cohort study. Setting The surgical unit at a major rural referral centre for North-Eastern Victoria servicing a population of 90 000. Participants General surgical patients (n = 649) admitted via the emergency department at Northeast Health Wangaratta between January 2011 and March 2013 undergoing operative management (n = 608) or transfer to a tertiary centre (n = 44). Main Outcome Measures Timing of operative management, using appendicectomy as a benchmark operation, was measured as time from presentation to decision to operate, time from decision to surgery, percentage after-hours operating and length of stay (LOS). Time to interhospital transfer was calculated and reasons for delay were sought. Results Two hundred forty-six appendicectomies were performed. Median time from decision to operate to theatre was 3 hours (interquartile range (IQR) 2–8), and total LOS was 43 hours (IQR: 28–56). Two hundred seventy-two procedures (43%) were performed out-of-hours, including 48% of appendicectomies. Median time from decision making to transfer was 10.3 hours (IQR: 4.7–25). Transfer was less likely to be delayed in trauma patients when compared with urgent non-trauma patients (5.3 versus 10.6 hours; P = 0.04). Conclusion Even in the absence of a strict four-hour rule program and a dedicated emergency surgical unit, main outcome measures appear to be comparatively efficient. However, the duration for transfer of patients is suboptimal because of the lack of established pathways for urgent non-trauma transfer from rural centres and bed availability in tertiary hospitals.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_________::b181535d88f64d601c7ea7644528bc7c https://doi.org/10.1111/ajr.12160 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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