| Summary: | 碩士 === 台北醫學院 === 醫學資訊研究所 === 88 === Background:
In the field of emergency medicine that interhospital transferring of acutely traumatized patients always the most dangerous situations for the patient care and if the receiving physician can get more information about the patient condition, the appropriate clinical management will be prepared before patient’s arrival. In the study, proposing the idea of safety transfer and implantation of the workflow of critical patient record and CT image referral system is one form of telemedicine that would allow the transmission of clinical data and radiographs images (CTs) before the transfer of acutely traumatized patients between referring and receiving hospitals to perform telediscussion . The purpose of this study was to evaluate the potential impacts of the workflow of critical patient record and CT image referral system on trauma patient management and safety transfer.
Methods:
28 emergency staffs and 28 selected injured patients who was triaged into level 1 or 2 emergency condition that referred between main hospital emergency department in Taipei metropolitan area and branch hospital in Tamsui area of Mackay Memorial Hospital, for the purpose of being under the service of traumatic care (operation or admitting to SICU) after first line resuscitation and who was needed to be arranged transferring to the other geographical hospital, were included. The first line resuscitation history, chief complains, physical examination, and radiographic images CTs, recorded in the computer-based patient record referral system by the referring physician to the receiving physician were documented. The clinical data and radiographic images (brain CT, or chest CT or abdominal pelvic CT) taken at the referring hospital were immediately through the workflow of critical patient record and CT image referral system sending to receiving physicians on that time immediately before patient transfer and perform telediscussion. For each case, two physician involved the receiving care plan was informed immediately to know all the clinical information of the critical patient by the workflow of critical patient record and CT image referral system; and at a later date (1 week) the randomized selected independently trauma fellow among the other 26 emergency staff who get all clinical information and transfer detail about the same case including outcome was individually evaluating the clinical data and radiographic images through the workflow of critical patient record and CT image referral system. The immediate receiving physicians (I) and later independently trauma fellow(L) were surveyed by designed questionnaires as to the implications of reviewing the whole clinical information and radiographic CT images transmitted by the workflow of critical patient record and CT image referral system taken at the referring hospital before patient transfer.
Results:
Overall, the physicians to the workflow of critical patient record and CT image referral system felt that viewing the radiographs and get as much information of all clinical data through the workflow before transfer and performing telediscussion would have influence on the trauma care and safety transfer, and 86%(I) and 93%(L) of cases as judged by immediate receiving physicians(I) and later independently trauma fellow(L), respectively. The physicians to the workflow of critical patient record and CT image referral system commonly noted the following five improvements than before as a result of safety transfer: enough clinical information, suitable condition for transfer, more reasonable suggested further pretransfer interventions and further pretransfer special consultation, and emphasized precautions about the method of transfer.
Conclusion: This study suggests that understanding the clinical information and radiographic images through the workflow of critical patient record and CT image referral system for traumatic critical patient’s transfer would have the potential influence on many aspects of the safety transfer management of interhospital transferring.
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