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Emergency medical service communication --- utilization --- Emergency medical service communication --- utilization

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EMERGENCY MEDICAL SERVICE COMMUNICATION SYSTEMS --- EMERGENCY MEDICAL SERVICE COMMUNICATION SYSTEMS

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Emergency medical service communication systems --- trends --- Emergency medical service communication systems --- trends

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Introduction : En Belgique le recours aux transferts interhospitaliers (TIH) est de plus en plus récurrent (1–6). Ces transferts sont des périodes à risque pour le patient et le personnel (7,8). Cependant, leur gestion dépend d’une organisation fragmentaire impactant parfois l’organisation du service d’urgence et de l’Aide Médicale Urgente (AMU). &#13;Objectif : Ce travail met au point un algorithme décisionnel, basé sur deux calculs de scores de risque. Ceux-ci permettraient d’encadrer la régulation des TIH en définissant un niveau d’urgence (délai de départ du transfert) et un niveau de gravité (composition de l’équipage). Ces scores se basent sur des critères objectifs et paramétriques du patient avant le transfert. L’objectif étant d’optimiser la sécurité de l’environnement dans lequel le patient est transféré.&#13;Population étudiée : La population cible regroupe les TIH réalisés entre le 10/05/2021 et le 6/06/2021 (phase I : n = 44), et entre le 14/06/2021 et le 11/07/2021 (phase II, n = 37), par des hôpitaux de la province de Liège disposant d’une fonction SUS (Service d’Urgence Spécialisé) et ayant accepté de participer à l’étude. &#13;Méthode : Cette étude quantitative est pré-expérimentale et pluri-centrique. Cette recherche s’est déroulée en deux phases, qui ont permis de comparer le déroulement des TIH sans l’utilisation des scores, et ensuite avec leur implémentation. Les données ont été collectées via des fiches d’évaluation du transfert et des scores. Les outils de collecte et les adaptations apportées aux scores de risque ont été testés par un pré-test et validés par des experts (groupe de travail TIH de la CoAMU, médecins/infirmiers des services SUS).&#13;Résultats : En phase I, le score de gravité (composition de l’équipe) obtenu concorde significativement avec ce qui est réalisé (pval 0,0097) et ce score a été appliqué et jugé adéquat de manière significative en phase II (pval 0,0005). Le score d’urgence (délai de départ du transfert) a été significativement appliqué et jugé adéquat par le médecin (pval <0,0001) en phase II, la concordance n’était pas significative en phase I. Pour ces deux scores, la concordance réelle est inférieure à 80% donc peu relevante/pertinente pour le domaine médical. Les pathologies à risque évolutif semblent moins adaptées à l’utilisation des scores. L’application des scores n’a pas engendré d’incident sur les transferts et ne diminue pas la perception de sécurité de l’équipe ni pour elle, ni pour le patient (pval toutes >0,05). &#13;Conclusion : L’utilisation de tels scores de risque dans le milieu des TIH en province de Liège permettrait au médecin de définir le niveau d’urgence et de gravité du transfert sur base d’éléments objectifs. Cependant, d’autres études avec un échantillon plus important seraient nécessaires pour confirmer l’utilisation la plus adéquate possible de ces scores. Introduction: In Belgium, there is a increase in the use of interhospital transfers (IHT) (1-6). These transfers are high-risk time periods for the patient and for the staff (7,8). However, their management depends on a fragmented organization and impacting sometimes the organization of the emergency department and the Emergency Medical Service (EMS).&#13;Objective: This research aims to develop an algorithm based on two risk score calculations. This would allow the IHT to regulate by defining a level of urgency (transfer starting time), and a level of severity (staff composition). These scores are based on objective and parametric criteria of the patient before the transfer. The purpose is to optimize the environment safety in which the patient is transferred. &#13;Study population: The target population includes IHT performed between May 5th 2021 and June 6th 2021 (phase I, n = 44), and between June 14th 2021 and July 11th 2021 (phase II, n = 37), by hospitals in the province of Liège that have an emergency unit and that agreed to participate in this study. &#13;Method: This quantitative study is pre-experimental and pluri-centric. This research included two phases, which compared the IHT first without the scores use, followed the implementation. The data is collected after the transfer and is noted in the scores evaluation sheets. The data collection tool and the adjustments made to the risk scores have been tested by a pre-test and validated by experts (CoAMU IHT work group, doctors/nurses from emergency units).&#13;Results: In the phase I, the severity score (staff composition) obtained was significantly consistent with what was performed (pval 0,0097). This score was applied and adequately judged in phase II (pval 0,0005). The emergency score (transfer starting time) was significantly applied and judged adequate by the doctor (pval < 0,0001) in phase II. The concordance was not significative in phase I. The effective concordance was lower than 80% for the two scores, therefore, not very relevant for the medical field. The pathologies with with progressive risk seem to be less appropriate to the scores use. The scores application did not lead to incidents during the IHT and did not decrease the staff security perception, neither for itself nor for the patient (pval > 0,05).&#13;Conclusion: The use of these risk scores in the IHT in the province of Liège would help the doctor to define the transfer emergency and severity levels based on objective components. However, further studies with a greater sample are necessary to confirm the more appropriate use of these scores.&#13;Keywords: Secondary transfer, interhospital transfer, Emergency Medical Service, risk score

Transfert secondaire --- transfert interhospitalier --- aide médicale urgente --- score de risque --- Secondary transfer --- interhospital transfer --- Emergency Medical Service --- risk score --- Sciences de la santé humaine > Anesthésie & soins intensifs

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