Are Emergency Medical Service & Hospital Care for Major Trauma Patients Inferior during Off-hours?
Date Issued
2007
Date
2007
Author(s)
Tsai, Ming-Lin
DOI
zh-TW
Abstract
Introduction: Traumatic injury, one of the most important leading causes of mortality, is the 5th cause of mortality in Taiwan and the 1st cause of mortality for people under the age 40 in Taiwan. Appropriate immediate and definite care for traumatic patients can decrease the mortality. To achieve this goal, trauma hospital categorization and effective trauma care system need to be implemented to send traumatic patients to right hospital as soon as possible. During off-hours, the decreasing in manpower and resource and the lack of experience among medical team increase the opportunity of medical errors. These factors may decrease the quality of emergency medical service and hospital care, and increase the morbidity and mortality of major trauma patients.
Objective: The goal of this study is to assess if the quality of emergency medical service and hospital care for major traumatic patients in Taipei are inferior during off-hours.
Materials and Methods: This study retrospectively collected traumatic patients who activated emergency medical services in Taipei and met the major trauma triage rule between February 1, 2002 and January 31, 2003. The working-hours are defined as the interval from 8 AM to 5PM on weekdays and off-hour are defined as the interval from 5PM to 8 AM on weekdays and weekends. Outcomes analysis include: medical resource utilities (rate of CT study, rate of chest X-ray study, rate of ultrasound study, rate of operation), time of trauma to arrival at emergency department, hospital process quality (time to operation room, length of stay in emergency department), patients` outcomes (hospital length of stay, length of stay of intensive unit care, mortality).
Results and Discussion: The study population was 638 patients from any a total 13,022 patients who activated emergency medical services in Taipei. There was no difference in the compliance with triage rule project between working-hours and off-hours (58% vs. 61%, p=0.48). The mean age was higher during working-hours (44 vs. 38, p=0.0005). During working-hours, the mortality was 13.5% compared with the 14.1% during off-hours (p=0.77). The mortality was highly correlated to the injury severity score>15 and age>55 (p<0.0001) but not the working-hours. Time of trauma to arrival at emergency department, hospital length of stay, and length of stay of intensive unit care are the same between working-hours and off-hours.
For center levels, the time to operation room (214 min vs. 285 min, p=0. 45) and length of stay in emergency department (270 min vs. 232 min, p=0. 54) are not different among medical center between working-hours and off-hours. However, there is a trend that the time to operation room and length of stay in emergency department were higher during off-hours in non-trauma center or non-medical center. However this result was not statistically significant.
The Pearson correlation coefficient was -0.12 and p-value was 0.88 between length of stay in emergency department and length of stay of intensive unit care. The Pearson correlation coefficient was -0.18 and p-value was 0.87 between length of stay in emergency department and hospital length of stay.
Conclusion: The mortality of major trauma patients in Taipei was the same between work-hours and off-hours. However, there was a trend that the quality of emergency medical service and hospital care for major traumatic patients in Taipei was inferior during off-hours. This trend did not exist in medical center.
Subjects
緊急醫療服務
重大創傷
非工作時間
emergency medical service
major trauma
off-days
hospital care
Type
thesis
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