Analysis of Interhospital Emergency Referrals Despite Safety Concerns on the Roads: Emergency Referrals in Northwest Syria intraregional Borders

Abstract

Aim: Our study aims to assess emergency patient transport between hospitals in the northwestern region of Syria. In this way, determining the patient profiles transferred in the region can help shed light on the reasons for avoidable transfers, reduce transfers, and reduce the risks associated with transfers. Material and Methods: Our retrospective study investigated the patients who were transferred to Azez Vatan Hospital, Çobanbey Hospital, and Jarablus Hospital and from these facilities within the borders of the northwestern region of Syria between 01/01/2020-01/01/2021. Transfer records of patients transferred between hospitals and ambulance stations were searched in files and computer records. Because there was no automation system in the healthcare facilities involved in the study, data were recorded manually on the data collection form and processed for statistical analysis. Statistical analyses of the study were performed as descriptive statistics of variables are reported as mean±standard deviation, median (min-max), and n (%). Statistical analyses of categorical variables were performed using the chi-square test and Fisher Freeman Halton Exact test. Results: The mean age of the patients of 899 patients included in the study was 33.68±26.80 years, 530(59.0%) were male and 369(41.0%) were female. 27.3% of patients were trauma patients and of both sexes. Male trauma patients were approximately 2.5 times more common than female trauma patients. Among pediatric transfers, trauma was present in one out of every three patients. Patients were most frequently transferred in February, March, and June and least frequently in January (p < 0.05). It was found that the need for adult, newborn, and pediatric intensive care, the need for medical material and equipment, the need for further examination/treatment, followed by the need for treatment under the supervision neurosurgeon, obstetric and gynecologist, cardiology specialist, or pediatrician. It was also noted that transfers for COVID-19 (SARS-CoV-2 Coronavirus Disease 2019) service needs due to the impact of the COVID-19 outbreak during the study period were among the most common reasons. COVID-19 falls, respiratory distress, traffic accidents, and acute MI were the most common diagnoses in all transferred age groups. Conclusion: In northwestern Syria, emergency patients are most often transferred from one hospital to another because they require all types of intensive care units, medical materials and equipment, advanced diagnostic treatment, and specialists in neurosurgery, obstetrics and gynecology, cardiology, and pediatrics. Increasing hospital capacity and qualifications of hospitals within the humanitarian response and increasing the number of specialists, may be considered to reduce inter-hospital transfers of emergency patients.