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首页> 外文期刊>Prehospital emergency care >Emergent and Urgent Transfers to Neurosurgical Centers in Ontario
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Emergent and Urgent Transfers to Neurosurgical Centers in Ontario

机译：紧急紧急转移到安大略省的神经外科中心

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Critically ill neurosurgical patients require expedient access to neurosurgical centers (NC) to improve outcome. In regionalized health systems patients are often initially evaluated at a non-neurosurgical center (NNC) and are subsequently transferred to a NC using air or ground vehicles. We sought to identify barriers to accessing a NC for critically ill patients by analyzing interfacility transfer times and referral patterns in the province of Ontario. A retrospective observational analysis was undertaken. The cohort included patients in Ontario with emergent and urgent neurologic pathologies who underwent transfer from a NNC to NC between January 1, 2011 and December 31, 2013. Timing, clinical, and geographic data were collected for each transfer. We identified 1103 emergent/urgent transfers. The median transfer time to a NC was 3.4h (IQR -2.2, 3.8) and varied by the geographic region of origin. A total of 17% of the patients bypassed a closer NC during transfer to their destination NC. Transfers that bypassed a closer NC travelled further (101 miles vs. 296 miles, p < 0.001), took longer (3.1h vs. 3.9h, p < 0.001), and in some regions were associated with a higher risk of in-transit clinical decline (3.0% vs. 8.3%, p < 0.05) when compared with transfers that ended at the closest NC. Regionalization of neurosurgical services in Ontario has led to heavy reliance upon patient transfers to maintain continuity of care. Access to a NC varied across the province, which may represent regional differences in neurosurgical bed availability, resource limitations at smaller NCs, or environmental factors. Our descriptions of referral patterns and transport times can guide health system planning in Ontario and similar jurisdictions in the United States and Canada.
机译：重症神经外科患者需要方便地进入神经外科中心（NC）以改善结局。在区域卫生系统中，通常通常首先在非神经外科中心（NNC）对患者进行评估，然后使用空中或地面车辆将其转移至NC。我们试图通过分析安大略省的医疗机构间转移时间和转诊方式，找出重症患者获得NC的障碍。进行回顾性观察分析。该队列包括安大略省2011年1月1日至2013年12月31日期间从NNC转移到NC的急诊和急诊神经系统疾病的患者。每次转移均收集了时间，临床和地理数据。我们确定了1103紧急/紧急转移。转移至NC的中位时间为3.4h（IQR -2.2，3.8），并随来源地理区域而变化。共有17％的患者在转移至目的地NC时绕过了近距离NC。绕过更近的NC的传输进一步传播了（101英里vs. 296英里，p <0.001），花费了更长的时间（3.1h vs. 3.9h，p <0.001），并且在某些地区与过境风险更高与最接近的NC结束的转移相比，临床下降（3.0％vs. 8.3％，p <0.05）。安大略省神经外科服务的区域化导致严重依赖患者转移以维持护理的连续性。全省使用NC的方式各不相同，这可能表示神经外科病床可用性的区域差异，较小NC的资源限制或环境因素。我们对转诊方式和运输时间的描述可以指导安大略省以及美国和加拿大类似司法管辖区的卫生系统规划。

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