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Interfacility transfer

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https://www.readbyqxmd.com/read/29763390/what-are-ethical-implications-of-regionalization-of-trauma-care
#1
Sandra R DiBrito, Christian Jones
Outcomes for severely injured patients are improved when they are treated at trauma centers. However, interfacility transfers can delay time-sensitive treatments not requiring the resources of tertiary institutions. Regionalized trauma systems allow physicians to decrease delays in care, prevent inadequate treatment, and ultimately reduce preventable deaths. Although precise risks and benefits of triage choices are unknowable, estimating them is a process well known to surgeons. Recognizing patient transfers as integral to optimal care delivery systems, rather than as detracting from them, is essential...
May 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29618623/interfacility-transfers-for-us-ischemic-stroke-and-tia-2006-2014
#2
Benjamin P George, Sara J Doyle, George P Albert, Ania Busza, Robert G Holloway, Kevin N Sheth, Adam G Kelly
OBJECTIVE: To investigate changes in emergency department (ED) transfers for ischemic stroke (IS) and TIA. METHODS: We performed a retrospective observational study using the US Nationwide Emergency Department Sample to identify changes in interfacility ED transfers for IS and TIA from the perspective of the transferring ED (2006-2014). We calculated nationwide transfer rates and individual ED transfer rates for IS/TIA by diagnosis and hospital characteristics. Hospital-level fractional logistic regression examined changes in transfer rates over time...
April 4, 2018: Neurology
https://www.readbyqxmd.com/read/29606684/en-route-care-provided-by-us-navy-nurses-in-iraq-and-afghanistan
#3
Virginia S Blackman, Benjamin D Walrath, Lauren K Reeves, Alejandra G Mora, Joseph K Maddry, Zsolt T Stockinger
BACKGROUND: US Navy nurses provide en route care for critically injured combat casualties without having a formal program for training, utilization, or evaluation. Little is known about missions supported by Navy nurses. OBJECTIVES: To characterize the number and types of patients transported and skill sets required by Navy nurses during 2 combat support deployments. METHODS: All interfacility casualty transfers between 2 separate facilities in Iraq and Afghanistan were assessed...
April 2018: Critical Care Nurse
https://www.readbyqxmd.com/read/29565527/pediatric-emergency-transport-communication-and-coordination-are-key-to-improving-outcomes
#4
Abraham Gallegos, Vijay Prasad, Calvin G Lowe
Pediatric patients who are critically ill or who require urgent subspecialty evaluation or specialized imaging, equipment, or procedures must often be transferred to tertiary care centers. The safe execution of interfacility transfer requires the coordination between the facility healthcare teams at each end of the transfer as well as the transport team. This issue discusses the process of interfacility transfer, the required services, the role of the emergency clinician, the role of the pediatric transport team, and the commonly used diagnostic studies and treatment needed during interfacility transfers of pediatric patients...
April 2018: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/29552995/the-economic-value-of-the-centers-for-disease-control-and-prevention-carbapenem-resistant-enterobacteriaceae-toolkit
#5
Sarah M Bartsch, Susan S Huang, James A McKinnell, Kim F Wong, Leslie E Mueller, Loren G Miller, Bruce Y Lee
OBJECTIVE While previous work showed that the Centers for Disease Control and Prevention toolkit for carbapenem-resistant Enterobacteriaceae (CRE) can reduce spread regionally, these interventions are costly, and decisions makers want to know whether and when economic benefits occur. DESIGN Economic analysis SETTING Orange County, California METHODS Using our Regional Healthcare Ecosystem Analyst (RHEA)-generated agent-based model of all inpatient healthcare facilities, we simulated the implementation of the CRE toolkit (active screening of interfacility transfers) in different ways and estimated their economic impacts under various circumstances...
March 19, 2018: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/29547887/an-evaluation-of-navy-en-route-care-training-using-a-high-fidelity-medical-simulation-scenario-of-interfacility-patient-transport
#6
Christine A DeForest, Virginia Blackman, John E Alex, Lauren Reeves, Alejandra Mora, Crystal Perez, Joseph Maddry, Domenique Selby, Benjamin Walrath
Introduction: Military prehospital and en route care (ERC) directly impacts patient morbidity and mortality. Provider knowledge and skills are critical variables in the effectiveness of ERC. No Navy doctrine defines provider choice for patient transport or requires standardized provider training. Frequently, Search and Rescue Medical Technicians (SMTs) and Navy Nurses (ERC RNs) are tasked with this mission though physicians have also been used. Navy ERC provider training varies greatly by professional role...
March 14, 2018: Military Medicine
https://www.readbyqxmd.com/read/29502890/issues-to-resolve-with-the-use-of-extracorporeal-membrane-oxygenation-during-interfacility-transportation
#7
P Burgueño, C González, A Sarralde, F Gordo
Extracorporeal membrane oxygenation (ECMO) support is indicated in patients who are refractory to treatment, those with cardiogenic shock or respiratory failure and those with exacerbations eligible for heart and lung transplantation. Physician experience and quantity of necessary resources are reasons why regionalization could benefit patients of this kind, establishing ECMO reference centers and integrating a transportation network specialized in ECMO. This type of transportation is a challenge for healthcare systems and physicians, given its greater complexity, requiring a multidisciplinary and inter-territorial approach...
March 1, 2018: Medicina Intensiva
https://www.readbyqxmd.com/read/29478576/safe-interfacility-transport-of-pediatric-patients-medical-control-training-an-interdisciplinary-approach
#8
Samantha W Gee, Philip L Holt, Michael J Stoner
INTRODUCTION: Critically ill children who require transfer to tertiary care centers often require transport by specialized transport teams (TT). These interfacility transports require a medical control physician (MCP). Traditionally this role is assigned to fellows who are taught "on-the-job", but achieving competency in communication for those trained this way may not be optimal. We sought to close this curriculum gap by developing a MCP training program immersing emergency medicine (EM) and critical care (CC) fellows together with TT members to manage a simulated patient...
March 2018: Air Medical Journal
https://www.readbyqxmd.com/read/29389838/too-little-too-late-hypotension-and-blood-transfusion-in-the-trauma-bay-are-independent-predictors-of-death-in-injured-children
#9
Christine M Leeper, Christine McKenna, Barbara A Gaines
BACKGROUND: Hypotension is a late finding in pediatric shock despite significant blood loss; consequently, recognition of hemodynamic compromise can be delayed. We sought to describe the impact of late stage shock in children, indicated by hypotension or trauma bay blood transfusion, and quantify the association with poor outcome. METHODS: Children age<18 from the Pennsylvania Trauma Outcome Study registry (2000-2013) were included. Primary outcome was mortality...
January 31, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29275369/regional-call-911-emergency-department-protocol-to-reduce-interfacility-transfer-delay-for-patients-with-st-segment-elevation-myocardial-infarction
#10
Nichole Bosson, Terrence Baruch, William J French, Andrea Fang, Amy H Kaji, Marianne Gausche-Hill, Alisa Rock, David Shavelle, Joseph L Thomas, James T Niemann
BACKGROUND: We evaluated the first-medical-contact-to-balloon (FMC2B) time after implementation of a "Call 911" protocol for ST-segment-elevation myocardial infarction (STEMI) interfacility transfers in a regional system. METHODS AND RESULTS: This is a retrospective cohort study of consecutive patients with STEMI requiring interfacility transfer from a STEMI referring hospital, to one of 35 percutaneous coronary intervention-capable STEMI receiving centers (SRCs)...
December 23, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29206726/standardization-of-pediatric-interfacility-transport-handover-measuring-the-development-of-a-shared-mental-model
#11
Anthony A Sochet, Kelsey S Ryan, Jennifer L Bartlett, Thomas A Nakagawa, Ladonna Bingham
OBJECTIVES: To determine if standardization of pediatric interfacility transport handover is associated with the development of a prototypical shared mental model between healthcare providers. DESIGN: A single center, prepost, retrospective cohort study. SETTINGS: A 259-bed, tertiary care, pediatric referral center. PATIENTS: Children 0 to 18 years old transferred to our critical care units or emergency center from October 2016 to February 2017...
February 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29167391/integrated-genomic-and-interfacility-patient-transfer-data-reveal-the-transmission-pathways-of-multidrug-resistant-klebsiella-pneumoniae-in-a-regional-outbreak
#12
Evan S Snitkin, Sarah Won, Ali Pirani, Zena Lapp, Robert A Weinstein, Karen Lolans, Mary K Hayden
Development of effective strategies to limit the proliferation of multidrug-resistant organisms requires a thorough understanding of how such organisms spread among health care facilities. We sought to uncover the chains of transmission underlying a 2008 U.S. regional outbreak of carbapenem-resistant Klebsiella pneumoniae by performing an integrated analysis of genomic and interfacility patient-transfer data. Genomic analysis yielded a high-resolution transmission network that assigned directionality to regional transmission events and discriminated between intra- and interfacility transmission when epidemiologic data were ambiguous or misleading...
November 22, 2017: Science Translational Medicine
https://www.readbyqxmd.com/read/29133262/911-emergency-medical-services-and-re-triage-to-level-i-trauma-centers
#13
Eric Kuncir, Dean Spencer, Kelly Feldman, Cristobal Barrios, Kenneth Miller, Stephanie Lush, Matthew Dolich, Michael Lekawa
BACKGROUND: Interfacility transfer of undertriaged patients to higher-level trauma centers has been found to result in a delay of appropriate care and an increase in mortality. To address this, for the last 10 years our region has used 911 emergency medical services (EMS) paramedics for rapid re-triage of undertriaged patients to our institution's Level I trauma center. We sought to determine whether using 911 EMS for re-triage to our institution was associated with worse outcomes-with mortality as the primary end point-compared with direct EMS transport from point of injury...
January 2018: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/29067633/implementation-of-continuous-video-electroencephalography-at-a-community-hospital-enhances-care-and-reduces-costs
#14
Brad J Kolls, Brian E Mace, Keith E Dombrowski
BACKGROUND: Despite data indicating the importance of continuous video-electroencephalography (cvEEG) monitoring, adoption has been slow outside major academic centers. Barriers to adoption include the need for technologists, equipment, and cvEEG readers. Advancements in lower-cost lead placement templates and commercial systems with remote review may reduce barriers to allow community centers to implement cvEEG. Here, we report our experience, lessons learned, and financial impact of implementing a community hospital cvEEG-monitoring program...
October 24, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28870269/failure-to-communicate-transmission-of-extensively-drug-resistant-bla-oxa-237-containing-acinetobacter-baumannii-multiple-facilities-in-oregon-2012-2014
#15
Genevieve L Buser, P Maureen Cassidy, Margaret C Cunningham, Susan Rudin, Andrea M Hujer, Robert Vega, Jon P Furuno, Steven H Marshall, Paul G Higgins, Michael R Jacobs, Meredith S Wright, Mark D Adams, Robert A Bonomo, Christopher D Pfeiffer, Zintars G Beldavs
OBJECTIVE To determine the scope, source, and mode of transmission of a multifacility outbreak of extensively drug-resistant (XDR) Acinetobacter baumannii. DESIGN Outbreak investigation. SETTING AND PARTICIPANTS Residents and patients in skilled nursing facilities, long-term acute-care hospital, and acute-care hospitals. METHODS A case was defined as the incident isolate from clinical or surveillance cultures of XDR Acinetobacter baumannii resistant to imipenem or meropenem and nonsusceptible to all but 1 or 2 antibiotic classes in a patient in an Oregon healthcare facility during January 2012-December 2014...
November 2017: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/28860727/the-role-of-caregivers-in-interfacility-care-transitions-a-qualitative-study
#16
Lianne Jeffs, Marianne Saragosa, Madelyn P Law, Kerry Kuluski, Sherry Espin, Jane Merkley
A qualitative design was used to explore the nature of caregiver involvement in care transitions of patients being transferred from an acute care hospital to a rehabilitation hospital. Participants included older adults (n=13), informal caregivers (n=9), and health care professionals (n=50) from inpatient orthopedic units in two academic health science centers and one orthopedic inpatient rehabilitation unit. Semistructured interviews were conducted, audio-taped, and transcribed. Directed content analysis revealed the following four themes: watching, being an active care provider, advocating, and navigating the health care system...
2017: Patient Preference and Adherence
https://www.readbyqxmd.com/read/28822393/identifying-futile-interfacility-surgical-transfers
#17
Kristy Kummerow Broman, Sharon E Phillips, Jesse M Ehrenfeld, Mayur B Patel, Oscar M Guillamondegui, Kenneth W Sharp, Richard A Pierce, Benjamin K Poulose, Michael D Holzman
Surgeons perceive that some surgical transfers are futile, but the incidence and risk factors of futile transfer are not quantified. Identifying futile interfacility transfers could save cost and undue burdens to patients and families. We sought to describe the incidence and factors associated with futile transfers. We conducted a retrospective cohort study from 2009 to 2013 including patients transferred to a tertiary referral center for general or vascular surgical care. Futile transfers were defined as resulting in death or hospice discharge within 72 hours of transfer without operative, endoscopic, or radiologic intervention...
August 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28754811/consistency-of-pressure-injury-documentation-across-interfacility-transfers
#18
Lee Squitieri, David A Ganz, Carol M Mangione, Jack Needleman, Patrick S Romano, Debra Saliba, Clifford Y Ko, Daniel A Waxman
BACKGROUND: Hospital-acquired pressure injuries (HAPIs) are publicly reported in the USA and used to adjust Medicare payment to acute inpatient facilities. Current methods used to identify HAPIs in administrative claims rely on hospital-reported present-on-admission (POA) data instead of prior patient health information. OBJECTIVE: To study the reliability of claims data for HAPIs and pressure injury (PI) stage by evaluating diagnostic coding agreement across interfacility transfers...
March 2018: BMJ Quality & Safety
https://www.readbyqxmd.com/read/28743480/the-influence-of-insurance-type-on-interfacility-pediatric-emergency-department-transfers
#19
COMPARATIVE STUDY
Chris A Rees, Stephanie Pryor, Ben Choi, Mamata V Senthil, Nicholas Tsarouhas, Sage R Myers, Michael C Monuteaux, Richard G Bachur, Joyce Li
BACKGROUND: Disparities exist in the care children receive in the emergency department (ED) based on their insurance type. It is unknown if these differences exist among children transferred from outside EDs to pediatric tertiary care EDs. OBJECTIVE: To compare reasons for transfer and services received at pediatric tertiary care EDs between children with private and public insurance. METHODS: We performed a secondary analysis of a multicenter survey of ED providers transferring patients to pediatric tertiary care EDs in three major U...
December 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28697156/transitions-of-care-the-presence-of-written-interfacility-transfer-guidelines-and-agreements-for-pediatric-patients
#20
Andrea Lynn Genovesi, Lenora M Olson, Russell Telford, Diana Fendya, Ellen Schenk, Theresa Morrison-Quinata, Elizabeth A Edgerton
OBJECTIVE: Every year, emergency medical services agencies transport approximately 150,000 pediatric patients between hospitals. During these transitions of care, patient safety may be affected and contribute to adverse events when important clinical information is missing, incomplete, or inaccurate. Written interfacility transfer policies are one way to standardize procedures and facilitate communication between the hospitals leading to improved patient safety and satisfaction for children and families...
July 11, 2017: Pediatric Emergency Care
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