Dealing with the Sick Rural Surgery Patient in Need of Transfer

Conyers, J. H.

doi:10.1016/j.suc.2020.06.009

Cited by 4 publications

(6 citation statements)

References 27 publications

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“…This is under the presumption that transfers are necessary, and certainly, that is the current case in Australia. An opinion piece by Conyers in 2020, listed three potential solutions to addressing healthcare disparities in large geographical regions, which were moving patient to expertise, moving expertise to patient or having expertise everywhere 43 . Since the first scenario is the current system and the third scenario is not feasible due to the size of Australia and the limited universal healthcare budget as discussed in the introduction, only the second scenario remains as a possible alternative that is worth exploring.…”

Section: Discussionmentioning

confidence: 99%

Predictors of interhospital transfer delays in acute surgical patient deaths in Australia: a retrospective study

Young

Kopunic

Trochsler

et al. 2022

ANZ Journal of Surgery

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Section: Discussionmentioning

confidence: 99%

Predictors of interhospital transfer delays in acute surgical patient deaths in Australia: a retrospective study

Young

Kopunic

Trochsler

et al. 2022

ANZ Journal of Surgery

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“…However, there are two disadvantages to this approach: Firstly, in these countries, patient transfer is often very time-consuming due to transportation infrastructure, and this delay can lead to a worse outcome when compared to patients who received immediate therapy [56,57]. Furthermore, the transfer of critically injured CMF patients is often not feasible [76,77]. Secondly, specialized cranio-maxillofacial centers are scarce in most LMICs, making this alternative unavailable in those regions, and requiring the patient to be referred for an alternative treatment [7].…”

Section: Discussionmentioning

confidence: 99%

Enhancing Cranio-Maxillofacial Fracture Care in Low- and Middle-Income Countries: A Systematic Review

Deininger,

Wichlas,

Necchi

et al. 2024

JCM

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Background: Cranio-maxillofacial (CMF) injuries represent a significant challenge in low- and middle-income countries (LMICs), exacerbated by inadequate infrastructure, resources, and training. This systematic review aims to evaluate the current strategies and solutions proposed in the literature to improve CMF fracture care in LMICs, focusing on education, patient transfer, and off-label solutions. Methods: A comprehensive literature search was conducted using PubMed/Medline from January 2000 to June 2023. Studies were selected based on the Preferred Reporting Items for Systematic Review and Meta-analysis Statement (PRISMA). Solutions were categorized into three main areas: education (digital and on-site teaching, fellowships abroad), patient transfer to specialized clinics, and off-label/non-operative solutions. Results: Twenty-three articles were included in the review, revealing a consensus on the necessity for enhanced education and training for local surgeons as the cornerstone for sustainable improvements in CMF care in LMICs. Digital platforms and on-site teaching were identified as key methods for delivering educational content. Furthermore, patient transfer to specialized national clinics and innovative off-label techniques were discussed as immediate solutions to provide quality care despite resource constraints. Conclusions: Effective CMF fracture care in LMICs requires a multifaceted approach, prioritizing the education and training of local healthcare professionals, facilitated patient transfer to specialized centers, and the adoption of off-label solutions to leverage available resources. Collaborative efforts between international organizations, local healthcare providers, and educational institutions are essential to implement these solutions effectively and improve patient outcomes in LMICs.

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“…Prior studies revealed that shortages of physicians and surgeons have steadily worsened in rural areas [ 18 – 20 ], leading to a lack of basic surgical access in small community hospitals [ 19 ]. While the service quality or resource availability of community hospitals may vary from case to case, supporting and improving the service level of small hospitals is a common challenge in many countries [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

“…When emergency care needs exceed the capacity and capability of regional hospitals, patients should be transferred to a larger hospital within a reasonable distance. However, in remote areas where medical resources are scarce, difficulties and delays in interhospital transfers may occur because there is not enough expertise nearby [ 1 ]. Furthermore, the arrangement for an interhospital transfer of a critically ill patient is a daunting and complex task for sending hospitals [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…It is quite burdensome to determine the destination without any preexisting interhospital relationship. The transfer coordinator should identify the resource availability of the referring hospital and negotiate the transfer [ 1 – 4 ]. In such a transfer process, a public coordinating service can offer practical assistance for an ED needing to transfer patients.…”

Section: Introductionmentioning

confidence: 99%

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Operation of national coordinating service for interhospital transfer from emergency departments: experience and implications from Korea

et al. 2023

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Background Since 2014, Korea has been operating the National Emergency Medical Situation Room (NEMSR) to provide regional emergency departments (EDs) with coordination services for the interhospital transfer of critically ill patients. The present study aimed to describe the NEMSR’s experience and interhospital transfer pattern from EDs nationwide, and investigate the factors related to delayed transfers or transfers that could not be arranged by the NEMSR. Methods This study was a retrospective cross-sectional analysis of the NEMSR’s coordination registry from 2017 to 2019. The demographic and hospital characteristics related to emergency transfers were analyzed with hierarchical logistic models. Results The NEMSR received a total of 14,003 requests for the arrangement of the interhospital transfers of critically ill patients from 2017 to 2019. Of 10,222 requests included in the analysis, 8297 (81.17%) successful transfers were coordinated by the NEMSR. Transfers were requested mainly due to a shortage of medical staff (59.79%) and ICU beds (30.80%). Delayed transfers were significantly associated with insufficient hospital resources. The larger the bed capacity of the sending hospital, the more difficult it was to coordinate the transfer (odds ratio [OR] for transfer not arranged = 2.04; 95% confidence interval [CI]: 1.48–2.82, ≥ 1000 beds vs. < 300 beds) and the longer the transfer was delayed (OR for delays of more than 44 minutes = 2.08; 95% CI: 1.57–2.76, ≥ 1000 beds vs. < 300 beds). Conclusions The operation of the NEMSR has clinical importance in that it could efficiently coordinate interhospital transfers through a protocolized process and resource information system. The coordination role is significant as information technology in emergency care develops while regional gaps in the distribution of medical resources widen.

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Dealing with the Sick Rural Surgery Patient in Need of Transfer

Cited by 4 publications

References 27 publications

Predictors of interhospital transfer delays in acute surgical patient deaths in Australia: a retrospective study

Predictors of interhospital transfer delays in acute surgical patient deaths in Australia: a retrospective study

Enhancing Cranio-Maxillofacial Fracture Care in Low- and Middle-Income Countries: A Systematic Review

Operation of national coordinating service for interhospital transfer from emergency departments: experience and implications from Korea

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