An evaluation of compliance and performance following the introduction of the Inter-Facility Transport Triage Guideline

BACKGROUND：In Hong Kong, the reorganization of healthcare frame work for better utilization of resources has led to an increase in the frequency of inter-facility transport in recent years. An Inter-Facility Transport Triage Guideline （IFTTG） was introduced and evaluated on its compliance and performance. This study aimed to evaluate the compliance to the IFTTG and performance of inter-facility transport after the IFTTG was implemented. METHODS： The patients who required emergency IFT with accompanying personnel in two consecutive periods （pre-implementation period： January 1,2006 to April 30, 2006; post-implementation period： May 1,2006 to August 31,2006） were included. The compliance to pre-transport triage and transport team configuration was evaluated by a review panel with eight performance indicators identified. The performance indicators were compared individually and as an overall score. RESULTS：Sixty-eight （26 in the pre-implementation period and 42 in the post-implementation period） IFTs were reviewed. There was demonstrable improvement on compliance to the IFTTG. The appropriateness of pre-transport triage increased from 34.6% to 54.8% whereas appropriateness of transport team configuration rose significantly from 73.1% to 92.9% （P〈0.05）. Staff performance on individual IFT performance indicator was satisfactory in both periods and the means of overall score on performance indicators were 7.12 and 7.29 respectively. The most improved performance indicator was the appropriateness of transport team configuration. CONCLUSIONS： The compliance and performance with the newly implemented IFTTG were satisfactory. However, staff comment and satisfaction with the use of the new guideline should be collected so as to achieve continuous quality improvement.

Treatment strategies for mass burn casualties

Background Mass burn casualties are always a great challenge to a medical team because a large number of seriously injured patients were sent in within a short time. Usually a high mortality is impending. Experiences gained from successful treatment of the victims may be useful in guiding the care of mass casualties in an armed conflict. Methods Thirty-five burn victims in a single batch, being transferred nonstop by air and highway from a distant province were admitted 48 hours post-injury. All patients were male with a mean age of （22.4±8.7） years. The burn extent ranged from 4% to 75% （（13.6±12.9）%） total body surface area. Among them, thirty-two patients were complicated by moderate and severe inhalation injury, and tracheostomy had been performed in 15 patients. Decompression incisions of burn eschar on extremities were done in 17 cases before transportation. All the thirty-five patients arrived at the destination smoothly via 4-hour airlift and road transportation. Among them, twenty-five patients were in critical condition. Results These thirty-five patients were evacuated 6 hours from the scene of the injury, and they were transferred to a local hospital for primary emergency care. The patients were in very poor condition when admitted to our hospital because of the severe injury with delayed and inadequate treatment. Examination of these patients at admission showed that one patient was suffering from sepsis and multiple organ dysfunction syndrome. Dysfunction of the heart, lung, liver, kidney, and coagulation were all found in the patients. Forty-eight operations were performed in the 23 patients during one month together with comprehensive treatment, and the function of various organs was ameliorated after appropriate treatment. All the 35 patients survived. Conclusions A well-organized team consisting of several cooperative groups with specified duties is very important. As a whole, the treatment protocol should be individualized, basing on the extent of the injury and the care that the patient had received at the spot. During airlift, the stretchers should be arranged perpendicular to the longitudinal axis of the cabin. The treatment protocol in our hospital consisted mainly of prompt effective relief of all life-threatening complications, followed by early closure of burn wounds, appropriate use of anti-infection therapy, emphasis on nutritional support, correction of metabolic disorders, alleviation of immunosuppression, correction of coagulopathy, and effective support and protection of organ function.

Noninvasive ventilation for pediatric interfacility transports:a retrospective study

Background To characterize pediatric patients supported with continuous positive airway pressure and bilevel positive airway pressure(CPAP/BiPAP)or high-flow nasal cannula(HFNC)during interfacility transport(IFT).Methods A retrospective study with a provincial pediatric transport team from a tertiary hospital pediatric intensive care unit.Pediatric patients aged 28 days to<17 years,who required IFT between January 2017 and December 2018,were identified through a transport registry and were included in the study.Results A total of 118(26.7%)patients received CPAP/BIPAP or HFNC support for IFT.The most common respiratory diagnosis was bronchiolitis(46%).These patients were placed on respiratory support,31.4 minutes after the transport team’s arrival.None required intubation during their IFT,despite mean transport times of 163 minutes.Conclusions This study may provide important information for programs with large catchment areas,in which large distances and transport times should not be barriers to NIV implementation.