Emergency Referrals Research Articles

Travel-associated illness in children in pre-pandemic Western Sydney, 2018-2020.

Observational cohort study. In the 18 months immediately before the COVID-19 pandemic (2018-2020), we prospectively collected demographic, travel and clinical data from children with travel-acquired illness or injury identified by active surveillance of CHW Emergency Department attendees and referrals to the infectious diseases service. We identified 587 returned child travellers with an illness or injury associated with overseas travel. Most were aged younger than 5 (62.8%) and had travelled within the Asia-Pacific region (84.6%). The main reason for travel, where recorded (50.3%), was visiting friends and relatives (VFR)(65.4%). Most travellers (90.1%) had a common childhood infection, illness or injury coincidentally acquired during travel, including respiratory infection (37.5%), acute diarrhoea (15.7%) and nonspecific febrile illness (13.1%). Exotic/nonendemic infections were uncommon (9.9%, including potential rabies exposure) but were associated with much higher admission rates than 'cosmopolitan' (globally distributed) diseases (74.2% vs 21.9%). Most of these occurred in VFR travellers (86.3%); enteric fever, largely acquired in South Asia, predominated (51.7%). One in five admitted patients had a disease for which specific pretravel vaccination is available. Receipt of pretravel vaccines was infrequently recorded. Returned child travellers in Western Sydney frequently presented with respiratory infections and may be a key population for surveillance of imported respiratory viruses. The burden of exotic disease was small and borne by VFR travellers. Travel-related illness in Western Sydney could be reduced by health education of travellers and targeted pretravel vaccination, especially typhoid vaccination for VFR travellers to South Asia. Universal, systematic screening of emergency department attendees for recent overseas travel would improve surveillance of travel-related illness.

Transient Ischaemic attack Emergency Referral (TIER): randomised feasibility trial results

BackgroundEarly assessment of patients with suspected transient ischaemic attack (TIA) is crucial to provision of effective care, including initiation of preventive therapies and identification of stroke mimics. Many patients with...

Key steps and barriers in the journey of patients with epilepsy through the National Healthcare System in Spain: The EPIPASS qualitative study.

Epilepsy requires continuous medical attention from multiple healthcare specialists, specialized facilities, and community-based care. In Spain, there is no standardized approach to epilepsy care. The aim of this study was to identify the factors impacting on the delivery of high-quality care by exploring key steps and barriers along the patient journey through the Spanish National Healthcare System (NHS). A qualitative study was conducted using opinions and experiences of neurologists, nurses, patients, and caregivers shared in discussion meetings. Using thematic content analyses, relevant aim-focused statements were coded according to prespecified issues in a discussion map (i.e., key steps and barriers), and sub-coded according to emerging issues. Thematic saturation and co-occurrence of key steps/barriers were evaluated to identify the most relevant factors impacting on the delivery of high-quality care. Sixty-five stakeholders took part in discussion meetings (36 neurologists, 10 nurses, 10 patients, and nine caregivers). Six key steps on the patient journey were identified: emergency care, diagnosis, drug therapy, follow-up, referral, and interventional treatment. Of these, follow-up was the most relevant step impacting on the delivery of high-quality patient care, followed by drug therapy and diagnosis. Emergency care was considered a hot-spot step with impact throughout the patient journey. Communication (among HCPs and between HCPs and patients) was a barrier to the delivery of high-quality care at several stages of the patient journey, including drug therapy, follow-up, referral, and interventional treatment. Resource availability was a barrier for diagnosis (especially for confirmation), drug therapy (drug availability), and referral (lack of professionals and specialized centers, and long waiting lists). This is the first study capturing perspectives of four key stakeholders involved in epilepsy care in Spain. We provide an overview of the patient journey through the Spanish NHS and highlight opportunities to improve the delivery of patient-centered care with a chronicity perspective. Patients with epilepsy may require prolonged medical care. In Spain, care is provided by a range of specialist and non-specialist centers. In this study, a team of Spanish neurologists, nurses, patients and caregivers identified barriers that affect the delivery of high-quality care for patients with epilepsy at each stage of their journey through the Spanish NHS. Specific epilepsy training for healthcare providers, appropriate resources for diagnosing and treating patients, and good communication between healthcare workers and patients were identified as important factors in providing high-quality care for patients with epilepsy.

Analysing referral patterns from a primary dermatological clinic to other medical institutions for further care: A survey on patients with certain skin diseases in Japan

AbstractBackgroundVarious skin diseases exist; some require specialist treatment. Consequently, patients with these conditions are often referred from primary dermatological clinics to other medical institutions for further secondary or tertiary care. However, it has yet to be fully evaluated at primary dermatological clinics which skin conditions necessitate such referrals.ObjectivesThis study aims to identify skin conditions that often require further care when treated at a primary dermatological clinic.MethodsThis study enroled 14,306 patients who had visited the Ueo Dermatology Clinic (a primary dermatological clinic in Saiki City, Oita prefecture, Japan) from 1 January 2020 to 31 December 2022. The following clinical information was examined: the primary disease, age, sex, whether referrals (general or emergency) were made after the clinic visit or not, and the reasons for the referrals.Results'Eczema and dermatitis' was the most frequent category in the clinic, although the referral rates for this category were not exceptionally high compared to other categories. A large number of emergency referrals was observed for 'Viral infections (herpes zoster),' 'Drug‐induced skin reactions,' and 'Bacterial infections (cellulitis)'; a large number of general referrals was observed for 'Malignant skin tumours and melanomas' and 'Benign skin tumours.' Although low numbers, the rates for general and emergency referrals were high in the categories of 'Blistering Diseases,' 'Connective Tissue Diseases,' and 'Vasculitis, Purpura, and Other Vascular Diseases.' In an analysis of the reasons for the referrals, the following reasons ranked highest: requirement for high‐level medical treatment, surgical operation, or hospitalisation, and consultation with doctors in departments other than dermatology.ConclusionsThis study identified several skin conditions often requiring additional care when treated at a primary dermatological clinic. Based on these findings, seamless cooperation between primary clinics and specialised medical institutions is anticipated.

Analysis of interhospital emergency referrals despite safety concerns on the roads: Emergency referrals in Northwest Syria intraregional borders

Objectives This study aims to assess emergency patient referrals between hospitals in the northwestern region of Syria. In this way, determining the patient profiles referred in the region can help shed light on the reasons for avoidable referrals, reduce referrals, and reduce the risks associated with referrals. Methods This retrospective study investigated the patients who were referred to AAA Hospital, BBB Hospital, and CCC Hospital and from these facilities within the borders of the northwestern region of Syria between 01/01/2020-01/01/2021. Referral records of patients transferred between hospitals and ambulance stations were searched in files and computer records. Because there was no automation system in the healthcare facilities involved in the study, data were recorded manually on the data collection form and processed for statistical analysis. Statistical analyzes of the study were performed as descriptive statistics of variables are reported as mean∓standard deviation, median (min-max), and n(%). Statistical analyzes of categorical variables were performed using the chi-square test and Fisher Freeman Halton Exact test. Results The mean age of the patients of 899 patients included in the study was 33.68∓26.80 years, 530(59.0%) were male and 369(41.0%) were female. 27.3% of patients were trauma patients and of both sexes. Male trauma patients were approximately 2.5 times more common than female trauma patients. Among pediatric referrals, trauma was present in one out of every three patients. Patients were most frequently referred in February, March, and June and least frequently in January (p < 0.05). It was found that the need for adult, newborn, and pediatric intensive care, the need for medical material and equipment, the need for further examination/treatment, followed by the need for treatment under the supervision neurosurgeon, obstetric and gynecologist, cardiology specialist, or pediatrician. It was also noted that referrals for COVID -19 (SARS-CoV-2 Coronavirus Disease 2019) service needs due to the impact of the COVID -19 outbreak during the study period were among the most common reasons. COVID -19, falls, respiratory distress, traffic accidents, and acute MI were the most common diagnoses in all referred age groups. Conclusion In northwestern Syria, emergency patients are most often referred from one hospital to another because they require all types of intensive care units, medical materials and equipment, advanced diagnostic treatment, and specialists in neurosurgery, obstetrics and gynecology, cardiology, and pediatrics. Increasing hospital capacity and qualifications of hospitals within the humanitarian response and increasing the number of specialists, may be considered to reduce inter-hospital referrals of emergency patients.

COVID-19 preparedness and response in the Pitcairn Islands: keeping one of the world's smallest and most isolated populations safe in a pandemic.

While the COVID-19 pandemic threatened the entire world, the extremely remote Pitcairn Islands faced unique vulnerabilities. With only a physician and a nurse to care for an ageing population of fewer than 40 residents, and with very limited referral pathways, Pitcairn encountered distinct challenges in preparing for and responding to the COVID-19 pandemic. The Pitcairn Islands is an overseas territory of United Kingdom of Great Britain and Northern Ireland consisting of four islands in the South Pacific: Pitcairn, Henderson, Ducie and Oeno. Pitcairn is the only inhabited island with a local resident population of approximately 31 people, around half of whom were over 60 years old in 2023. The islands are only accessible by sea and are located more than 2000km from the nearest referral hospital in French Polynesia. Pitcairn's Island Council took aggressive action to delay the importation of SARS-CoV-2, vaccinate its small population and prepare for the potential arrival of the virus. As of May 2024, Pitcairn was one of the only jurisdictions in the world not to have had a single COVID-19 hospitalization or death. Nevertheless, the pandemic presented the islands' population with many economic, social and health challenges. Pitcairn's population avoided COVID-19-related hospitalizations and deaths despite its elderly population's vulnerability to COVID-19, a significant level of comorbidities, and limited clinical management capabilities and options for emergency referrals. The pandemic highlighted some of the population's health vulnerabilities while also underscoring some of their innate strengths.

The associations of adherence to the Mediterranean diet with chronic dizziness and imbalance in community-dwelling adults: KNHANES 2019–2021

BackgroundDizziness and vertigo rank among the top 10 reasons for emergency and clinical referrals to neurologists. Chronic dizziness and imbalance not only reduce quality of life, but also increase mortality. While the Mediterranean diet has long been considered beneficial for human and planetary health, its effects on chronic dizziness or imbalance are understudied. We investigated the associations of adherence to the Mediterranean diet with chronic dizziness and imbalance.MethodsThis study used data from the Korea National Health and Nutrition Examination Survey 2019–2021 and included 4,183 adults aged 40 years and older with complete information from diet, dizziness, and neurotology questionnaires. The alternate Mediterranean diet score (aMed) for nine food groups was calculated from 24-hour dietary recall data. Based on questionnaire responses, chronic dizziness was categorized as either isolated or chronic dizziness with imbalance, characterized by a cluster of difficulties maintaining a standing position, walking, or falling.ResultsIn a multivariable-adjusted model, the prevalence of chronic imbalance was lower in the top aMed tertile than in the bottom tertile (OR 0.37; 95% CI, 0.18–0.74; p-trend = 0.01). Among the individual aMed components, the intake of whole grains and nuts exhibited an inverse relationship with chronic imbalance (OR 0.50; 95% CI, 0.27–0.93 for whole grains; OR 0.55; 95% CI, 0.31–1.01 for nuts). The aMed score was not associated with isolated chronic dizziness.ConclusionsGreater adherence to the Mediterranean diet may reduce chronic imbalance, particularly with an adequate intake of whole grains and nuts.

Reasons for encounters, diagnoses, and admission rate among emergency referrals at an urban primary care clinic in Japan: A retrospective cohort study

AbstractBackgroundComprehensive understanding of emergency referrals (EmR), encompassing reasons for encounters (RFEs) and diagnoses, is crucial for primary care physicians (PCPs). Comparing EmR rates and subsequent admission rates can potentially enhance the quality of primary care for EmR practice. However, no study has evaluated RFEs among patients with EmRs. This study aimed to identify RFE/diagnosis in relation to subsequent admission among patients receiving EmR.MethodsWe conducted a retrospective cohort study at an urban family physician teaching clinic in Kawasaki City, Japan. Our cohort recruited consecutive EmR episodes with their medical records and admissions confirmed through response letters from receiving hospitals. Using the 2nd edition of the International Classification of Primary Care, we explored the frequency of RFEs and diagnoses, calculating EmR rates and admission rates as primary outcomes. Bivariate analyses were employed to compare admission and non‐admission cases.ResultsThe present study encompassed 162 EmR episodes out of 47,901 visits, yielding an EmR rate of 3.38/1000 visits. Among 153 completely followed episodes, 99 patients were emergently admitted, resulting in a 64.7% admission rate. The admission group exhibited significantly higher age and a greater prevalence of dementia. Descriptive analysis revealed fever and pneumonia as the most frequent RFE and diagnosis, respectively, with significant differences between admission and non‐admission groups.ConclusionsThe present study reports EmR and admission rates following EmR, highlighting differences in patient characteristics, RFEs, and diagnoses. The findings offer insights to enhance PCPs' EmR practices and serve as a benchmark for the scope of EmR practice.

Understanding referral of patients with cancer in rural Ethiopia: a qualitative study

BackgroundCancer incidence is increasing in Ethiopia mainly due to increased life expectancy, while oncological capacities remain limited. Strong referral linkages between different levels of the healthcare system are key to provide timely access to cancer care. In this qualitative study, we assessed limitations and potential of cancer patient referral in the rural Southwest of Ethiopia.MethodsWe held four focus group discussions (FGD) with health professionals at one primary and three secondary hospitals and conducted eight in-depth interviews (IDI) with the hospitals´ medical executives and local health bureau representatives. Data was analysed inductively using thematic analysis and emerging themes were categorized within the revised concept of access by Penchansky and Saurman.ResultsThe inevitable referral of patients with cancer in the rural Southwest of Ethiopia is characterized by the absence of clear communication protocols and the lack of formal referral linkages. The newly implemented hub-system has improved emergency referrals and could be expanded to non-emergency referrals, sensitive to the needs of advanced oncological care. Liaison officers can pave the way but need to be trained and equipped adequately. Referred patients struggle with inadequate transportation systems, the lack of accommodation close to specialized facilities as well as the inability to navigate at those sites due to language barriers, illiteracy, and stigmatization. Few Non-Governmental Organizations (NGOs) help but cannot compensate the limited governmental support. The shortage of medications at public hospitals leads to patients being directed to costly private pharmacies. In the light of those challenges, cancer remains to be perceived as a “death sentence” within the rural communities.ConclusionsStandardized referral linkages and a multi-faceted support network throughout the cancer care continuum are necessary to make oncology care accessible to Ethiopia´s large rural population.

The Development and Evaluation of the Mobile Obstetric Referral Emergency System (MORES) in Bong County, Liberia [ID 2683571

INTRODUCTION: Liberia and much of sub-Saharan Africa lacks a standard triage system for obstetric emergencies. Research conducted in low- and middle-income (LMICs) has shown that maternal mortality is directly related to inadequate triage systems. This study aimed to implement a novel mobile obstetric referral emergency system to improve obstetric triage in Liberia. METHODS: Ninety-seven midwives were recruited from 18 rural health facilities (RHFs) and two referral hospitals in Bong County, Liberia. The study utilized WhatsApp, an encrypted messaging platform, to enable communication between providers at RHFs and referral hospitals. Training sessions at RHFs on sending patient referral data including indication, age, gravidity/parity, gestational age, method of transportation, and delays were conducted. Midwives at referral hospitals were instructed to send messages confirming arrival and outcome. RESULTS: A total of 380 referral messages were sent, with significantly more referrals completing the referral process than not (60%). Both hypertension and hemorrhage accounted for 12% of referrals. Nonemergent obstetric causes accounted for 34%. Of women who arrived, 31% delivered via cesarean section. Significantly more women transported via ambulance arrived compared to self-transport or taxi. When money was identified as a barrier, only 45% of women arrived. CONCLUSION: This is the first study to introduce a real-time two-way mobile-phone obstetric triage platform for use in Liberia. Strengthening the obstetric triage system is critical to prevent delays in reaching care and improve obstetric outcomes. Addressing socioeconomic barriers is vital to increasing access to maternal health care. Future work includes country-wide scale-up in Liberia and assessment of the sustainability of the MORES intervention.

A network of care to improve the continuity and quality of maternal and perinatal services in Makueni County, Kenya: study protocol

Background Kenya’s high maternal and perinatal mortality rates exceeds its recommended 2030 targets. The lack of effective collaboration between health facilities and workers contributes to delays and uncoordinated provision of care, leading to negative maternal and neonatal health (MNH) outcomes. Network of Care (NOC) is an effective strategy to improve health facility network efficiencies and MNH outcomes. Utilizing NOC to improve health system coordination and MNH outcomes in Kenya has not been studied. We present a study protocol for implementation research to investigate the feasibility and acceptability of establishing a county-level NOC on relationships among health facilities and workers, the feasibility of NOC for the Makueni county health system, and the impact of NOC on the quality of MNH services and emergency referrals within the county health system. Levels of communication, collaboration, and trust between NOC health facilities and levels of preparedness for management of MNH complications are also evaluated. Methods The study employed a mixed methods design with quantitative data from health worker self-administered phone surveys, health facility referral forms, and facility registers collected at baseline, then every three months from September 2021 to July 2023. Health worker focus group discussions and county management key informant interviews were conducted at baseline, midline, and endline. The study purposively selected 60 public and private health facilities in Makueni. These facilities were a sub-sample of 344 facilities with the highest maternity caseloads. A descriptive and thematic analysis of communication, collaboration, and trust between NOC health facilities and workers, and referral system changes will take place. Trend analysis of MNH indicators for Makueni from the Kenya Health Information System will be done. Conclusion This study aims at informing decision-makers locally and globally on whether NOC is feasible and acceptable as a county-level model of care in Kenya with application to similar LMIC settings.

Trends and Inequalities in Maternal and Newborn Health Services for Unplanned Settlements of Lusaka City, Zambia.

Living conditions and other factors in urban unplanned settlements present unique challenges for improving maternal and newborn health (MNH), yet MNH inequalities associated with such challenges are not well understood. This study examined trends and inequalities in coverage of MNH services in the last 20 years in unplanned and planned settlements of Lusaka City, Zambia. Geospatial information was used to map Lusaka's settlements and health facilities. Zambia Demographic Health Surveys (ZDHS 2001, 2007, 2013/2014, and 2018) were used to compare antenatal care (ANC), institutional delivery, and Cesarean section (C-section) coverage, and neonatal mortality rates between the poorer 60% and richer 40% households. Health Management Information System (HMIS) data from 2018 to 2021 were used to compute service volumes and coverage rates for ANC1 and ANC4, and institutional delivery and C-sections by facility level and type in planned and unplanned settlements. Although the correlation is not exact, our data analysis showed close alignment; and thus, we opted to use the 60% poorer and 40% richer groups as a proxy for households in unplanned versus planned settlements. Unplanned settlements were serviced by primary centers or first-level hospitals. ZDHS findings show that by 2018, at least one ANC visit and institutional delivery became nearly universal throughout Lusaka, but early and four or more ANC visits, C-sections, and neonatal mortality rates remained worse among poorer than richer women in ZDHS. In HMIS, ANC and institutional delivery volumes were highest in public facilities, especially in unplanned settlements. The volume of C-sections was much greater within facilities in planned than unplanned settlements. Our study exposed persistent gaps in timing and use of ANC and emergency obstetric care between unplanned and planned communities. Closing such gaps requires strengthening outreach early and consistently in pregnancy and increasing emergency obstetric care capacities and referrals to improve access to important MNH services for women and newborns in Lusaka's unplanned settlements.

Maternal mortality review in a major tertiary referral hospital in Liberia, 2018–2021

ObjectivesAnecdotal evidence showed increased maternal deaths at the major tertiary hospital over the past two years (2020–2021). We reviewed the maternal death audit data, identified the main causes of maternal death, and associated risk factors. Findings were shared with policymakers to help reduce maternal mortality. Study designWe conducted a secondary data review and descriptive analysis of maternal death at the tertiary hospital located in Monrovia. MethodThe maternal death data were extracted from patient medical records, including death certificates and maternal audit records. The record of live births was obtained from the delivery register. Data were analyzed using Epi Info version 7.2 Maternal mortality ratio (MMR) was estimated, the leading direct and indirect causes of maternal death were identified, and the factors associated with maternal death were explored using logistic regression at a 5% level of significance. ResultsThere are a total of 233 maternal deaths and 14, 879 live births giving a maternal mortality ratio (MMR) of 1565 per 100,000 live births during the period under review. The median age of the mothers at death was 29 (14–45) years. About 40.3% (94/233) of cases died within <1 day of admission, referrals accounted for 59% (137/233) of the cases. Direct causes of death accounted for 66% (147/223). Hemorrhage [30.6% (45/147)], Eclampsia [(30/147) 20.6%] and Sepsis [(30/147) 20.6%] were the main direct causes of death while cardiovascular-related [18.4% (14/76)] and HIV/AIDS [16% (12/76)] were the leading indirect cause of death. Patients from referred other facilities were 7.9 times more likely to die as compared to non-referral (pOR:7.9, 95%CI: 5.9–10.6, p < 0.001). ConclusionThe maternal mortality ratio remained high. Referrals were done late. The Liberia Ministry of Health should equip more secondary-level health facilities and tertiary hospitals to handle maternal emergencies and sensitize the populace and healthcare workers on prompt identification and referral of obstetric emergencies. The MoH also needs to improve the blood transfusion services to help in the management of postpartum hemorrhage.

Appropriateness of the Emergency Referrals Made by Primary Care Clinicians: A cross-sectional review of referral notes.

This study aimed to evaluate the appropriateness of the emergency referrals made by primary care clinicians and determine the factors contributing to inappropriate referrals. This cross-sectional study utilises referral notes review between October 2019 and March 2020. Patients referred to Khawla Hospital's emergency department by a primary care clinician in Muscat Governorate were randomly selected; their referral notes were reviewed by five family physicians. The appropriateness of the referrals was evaluated according to the primary care referral protocol. Any referral that deviated from the protocol was classified as inappropriate. The prevalence and characteristics of inappropriate referrals were identified, and the factors contributing to inappropriate referral were determined using multivariable logistic regression. In total, 591 referrals were reviewed; 354 (59.9%) of them were classified as inappropriate due to inadequate medical notes (291, 82.2%), lack of provisional diagnosis (176, 49.7%), misdirected to a non-concerned emergency (30, 8.4%) or misclassification of urgency (107 [30.2%] were classified as urgent and 45 [12.7%] as routine). After adjusting for multiple variables, insufficient clinical notes, unavailability of referral guidelines and lack of expertise were found to be strong determinants of inappropriate referral, with an odds ratio of 62.52 (95% confidence interval [CI]: 32.04-121.96), 2.88 (95% CI: 1.40-5.92) and 9.37 (95% CI: 4.09-21.43), respectively. While most of the referrals required emergency management, the majority were inappropriate, mainly due to insufficient clinical documentation. Inadequate clinical notes and lack of national guidelines and expertise were found to be strong predictors of inappropriate emergency referrals.

Experiences of delivering and receiving mental healthcare in the acute hospital setting: a qualitative study

BackgroundRecent investment in UK liaison psychiatry services has focused on expanding provision for acute and emergency referrals. Little is known about the experiences of users and providers of these services. The aim of this study was to explore the experiences of users of acute liaison mental health services (LMHS) and those of NHS staff working within LMHS or referring to LMHS. A secondary aim was to explore the potential impact of a one-hour service access target on service delivery.MethodsCross-sectional qualitative study. Individual interviews were audio-recorded, transcribed verbatim and interpreted using framework analysis.ResultsService users reported mixed experiences of LMHS, with some reporting positive experiences and some reporting poor care. Most service users described the emergency department (ED) environment as extremely stressful and wished to be seen as quickly as possible. Staff described positive benefits of the one-hour access target but identified unintended consequences and trade-offs that affected other parts of the liaison service.ConclusionsThe assessment and treatment of people who attend ED with mental health problems needs to improve and particular attention should be given to the stressful nature of the ED environment for those who are extremely agitated or distressed.

Assessing Medical Emergency E-referral Request Acceptance Patterns and Trends: A Comprehensive Analysis of Secondary Data From the Kingdom of Saudi Arabia.

Introduction Patient transfers in emergencies have been linked to reduced mortality rates and enhanced quality of care. The Saudi Medical Appointments and Referrals Centre (SMARC), an e-referral system in the Kingdom of Saudi Arabia (KSA) since 2019, plays a crucial role in ensuring quality and continuity of care. The findings of this study can provide valuable insights into the effectiveness of the e-referral system and identify potential areas for improvement in the management of emergency cases. Objective This study aims to examine e-referral patterns for emergency medical cases throughout all 13 administrative regions of KSA. Concurrently, it estimates the acceptance rate of medical emergency referrals and investigates associated factors among KSA hospitals. Methods This retrospective study utilized secondary data from the SMARC e-referral system, specifically focusing on medical emergency e-referral requests in the entire KSAduring 2021. Descriptive univariate analyses were conducted to characterize the referral requests, followed by bivariate analyses to explore associations between factors and referral acceptance. Adjusted multiple logistic regression analyses were then performed to calculate adjusted odds ratios (ORs) and corresponding 95% confidence intervals, controlling for potential confounding variables. Results A total of 29,660 medical emergency referral requests were initiated across all regions of KSA during the study time frame, and, of these,20,523 (69.19%)were accepted. The average age of patients with a medical emergency referral was 52 years old, and referral requests were higher among Saudis (13,781; 54.18%), males (13,781; 54.18%), and those from the Western region (10,560; 35.60%). Nearly 20,854 (70%) were due to the unavailability of specialized doctors or specialties in facilities. Based on multi-logistic regression, referral request acceptance was high in some factors as follows: compared to the Central region, requests from the Northern, Southern, Eastern, and Western regions had higher acceptance rates at 123%, 64%, 54%, and 46%, respectively. In addition, referral requests that were due to the unavailability of a specialized doctor or medical equipment had higher acceptance rates (19% and 16%), respectively, than those due to the unavailability of a specific specialty. Conclusion This study provides valuable insights into regional variations, sociodemographic factors, and referral reasons within the medical emergency e-referral system in the KSA. By estimating the acceptance rate of medical emergency referrals and investigating associated factors, this analysis confirms the effectiveness of the e-referral system in facilitating access to quality care, particularly for marginalized patients. The study highlights the need for health policy improvements to ensure equitable resource allocation and reduce disparities in healthcare access.

Public Health Center Emergency Referral Quality Analysis: Based on National Standard

The referral quality will affect the outcome of referred patients. The quality of emergency referrals from the Public Health Center (PHC) in Banten Province has not been examined. This study aims to analyze the quality of emergency referrals from PHC and the factors that influence it. Observational analytics with a retrospective approach to a PHC in Banten Province, Indonesia. The reference data for March-May 2023 is taken consecutively. Data on the demographics of referrers and referral cases are recorded. The quality of referrals is analyzed using national personal referral standards. A total of 52 referral cases were involved in the study. Referrals were made by nurses with an average age of 28.2 years with a range of 23-43 years, men (38/73.1%), and with diploma education (30/57.7%). Most of the referring nurses have a valid Basic Life Support (BLS) certificate (46/88.5), are non-civil servants, and work for an average of 3.3 years. Most of the referred cases are surgical (28/53.8) and urgency cases (32/61.5). Forty-four referral cases (84.6%) did not meet national referral standards. The referring nurse's educational background and the urgency of the case had a significant relationship with the quality of referrals with p values &lt; α values of 0.05 (0.000 and 0.000 respectively). There was no significant relationship between referral quality and patient/family satisfaction. Conclusion: Most PHC's emergency referrals to hospital emergency departments (ED) have not complied with national standards. There was a significant relationship between the education of the referring nurse and the level of urgency of the case with the quality of PHC referrals. There is no relationship between referral quality and patient/family satisfaction. National technical guidelines for individual referrals for emergency cases are needed.

Evaluation of video visit appropriateness for common symptoms seen in primary care: A retrospective cohort study.

Little is known about which conditions seen in primary care are appropriate for video visits. This study evaluated video visits compared to office visits for six conditions: abdominal pain, joint pain, back pain, headache, chest pain, and dizziness. Six hundred charts of adult patients from our institution's same-day outpatient clinic were reviewed in this study. Charts for video visits evaluating the aforementioned chief complaints that occurred between August and October 2020 were reviewed and compared with charts for office visits that occurred from August to September 2019. Frequencies of 3-week follow-up visits, Emergency Room visits, imaging, and referrals for office and video visits were measured. Reasons for in-person evaluation for patients seen by video were determined by review of clinician notes. Three-week in-person follow-up was more frequent for patients presenting with chest pain (52% vs 18%, p = 0.0007) and joint pain (24% vs 8%, p = 0.05) after video evaluation, relative to an office evaluation. Three-week in-person follow-up was also more frequent for patients presenting with dizziness (38% vs 28%) and low back pain (24% vs 14%); however, this difference was not statistically significant. Patients presenting with headache and abdominal pain did not have a higher rate of follow-up. Based on the frequency of in-person follow-up, this study suggests that video visits are generally adequate for evaluating headache and abdominal pain. Patients with dizziness and chest pain have the highest frequency of in-person and Emergency Room follow-up within 3 weeks when first seen by video compared to other conditions evaluated and may be less suitable for an initial video visit. Institutions can consider these findings when scheduling and providing guidance to patients on what type of visit is most appropriate for their symptoms.

Showcasing the Saudi e-referral system experience: the epidemiology and pattern of referrals utilising nationwide secondary data.

Referrals are an integral part of any healthcare system. In the Kingdom of Saudi Arabia (KSA) an electronic referral (e-referral) system known as the Saudi Medical Appointments and Referrals Centre (SMARC) began formally functioning in 2019. This study aims to showcase the Saudi experience of the e-referral system and explore the epidemiology of referrals nationally. This retrospective descriptive study utilised secondary collected data between 2020 and 2021 from the SMARC system. Cross tabulations with significance testing and colour-coded maps were used to highlight the patterns across all regions. The study analysed over 600,000 referral requests. The mean age of patients was 40.70 ± 24.66 years. Males had a higher number of referrals (55.43%). Referrals in 2021 were higher than those in 2020 (56.21%). Both the Autumn and Winter seasons had the highest number of referrals (27.09% and 27.43%, respectively). The Surgical specialty followed by Medicine had the highest referrals (26.07% and 22.27%, respectively). Life-saving referrals in the Central region were more than double those in other regions (14.56%). Emergency referrals were also highest in the Southern regions (44.06%). The Central and Eastern regions had higher referrals due to unavailable sub-speciality (68.86% and 67.93%, respectively). The Southern regions had higher referrals due to both unavailable machine and unavailable beds (18.44% and 6.24%, respectively). This study shows a unique system in which referrals are between secondary, tertiary, and specialised care. It also highlights areas of improvement for equitable resource allocation and specialised care in slightly problematic areas as well as the use of population density in future planning.

A comparative analysis of chronic inducible urticaria in 423 patients: Clinical and laboratory features and comorbid conditions.

Chronic inducible urticaria (CIndU) is a subtype of chronic urticaria (CU) which require specific physical or non-physical triggers to occur. They may be isolated or may coexist with chronic spontaneous urticaria (CSU). Despite their frequent appearance in dermatology clinics, there is scarce information on the distinguishing features among the most common subtypes of CIndU as well as isolated CIndU versus CSU plus CIndU. To compare clinical and laboratory characteristics, and comorbid conditions among the most common CIndU types and isolated CIndU versus CSU plus CIndU. We retrospectively analysed CIndU patients and compared patients' demographic, clinical and laboratory characteristics across isolated CIndU, CSU plus CIndU, symptomatic dermographism (SD), cold urticaria (ColdU) and cholinergic urticaria (ChoU). A total of 423 patients (~70% isolated CIndU, ~30% CSU plus CIndU, ~5% mixed CIndU subtypes) were included in the study. The most frequent CIndU subtypes were SD (68.6%; 290/423), ColdU (11.4%; 48/423) and ChoU (10.9%; 46/423). Isolated CIndU patients were younger than CSU plus CIndU (33.74 ± 12.72 vs. 37.06 ± 11.84, p = 0.010). Angioedema, emergency referrals, need for systemic steroids, comorbid systemic disorders were more frequent and baseline urticaria control test scores were lower in CSU plus CIndU patients (vs. CIndU, p < 0.001, p = 0.008, p < 0.001, p = 0.031, p = 0.036, respectively). Among CIndU subtypes, ChoU patients were younger (24.9 ± 12.2 vs. 34.47 ± 12.12 vs. 31.38 ± 14.95; p < 0.001) and had male predominance (p < 0.001) while SD patients had no angioedema (p < 0.001) and had higher frequency of increased total IgE levels (p = 0.006). Isolated CIndU and CSU plus CIndU seems to be different endotypes of CU where CSU plus CIndU presents a more severe and refractory course. There are distinctive features of each CIndU subtype. These suggest involvement of different pathomechanistic pathways in these subtypes that need to be clarified in future studies.