Interhospital Communication Research Articles

Inter‐hospital Communications and Transport: Turning One‐way Funnels Into Two‐way Networks

The Inter-hospital Communications and Transport workgroup was charged with exploring the current status, barriers, and data necessary to optimize the initial destination and subsequent transfer of patients between and among acute care settings. The subtitle, "Turning Funnels Into Two-way Networks," is descriptive of the approach that the workgroup took by exploring how and when smaller facilities in suburban, rural, and frontier areas can contribute to the daily business of caring for emergency patients across the lower-acuity spectrum-in some instances with consultant support from academic medical centers. It also focused on the need to identify high-acuity patients and expedite triage and transfer of those patients to facilities with specialty resources. Draft research recommendations were developed through an iterative writing process and presented to a breakout session of Academic Emergency Medicine's 2010 consensus conference, "Beyond Regionalization: Integrated Networks of Emergency Care." Priority research areas were determined by informal consensus of the breakout group. A subsequent iterative writing process was undertaken to complete this article. A number of broad research questions are presented.

Hospital disaster preparedness in Los Angeles County, California

Study objectives: We characterize disaster preparedness among a cohort of hospitals, focusing on practice variation, plan characteristics, and surge capacity.Methods: This was a descriptive, cross-sectional study using an in-person hospital survey and a 117-item questionnaire in Los Angeles County, CA. The study included 45 of the 81 designated 911 receiving hospitals, including private and tertiary care facilities. Observations include a description of hospital disaster plans, modes of intra- and interhospital communication, community and interagency involvement, decontamination capability and training, drills, pharmaceutical stockpiles, and each facility's surge capacity (assessed by monthly emergency department [ED] diversion status, number of available beds, ventilators, and negative pressure isolation rooms). Additional measures of preparedness included whether hospitals had the following: mutual aid agreements with other hospitals, long-term care facilities, and medical vendors; protocols for canceling elective surgeries and early in-patient discharge; surveillance systems; ongoing training with local emergency medical services and fire departments; communication with the public health department; volunteer credentialing systems; and a protocol for mass fatality incidents.Results: Ninety-five percent had adopted the Hospital Emergency Incident Command System, and 100% used the ReddiNet, a radio-based communications network. Ninety-five percent had memoranda of understanding with medical suppliers. However, 67% never had joint training programs with local police and fire agencies, and only 16% and 7% had written mutual aid agreements with other hospitals and long-term care facilities, respectively. Eighty-eight percent of hospitals had level B and/or C personal protective equipment, and 44% had decontamination facilities suitable in inclement weather. Ninety-six percent of respondents noted a nurse shortage, 58% had a monthly ED diversion rate of greater than 20%, and 69% estimated a surge capacity of less than 20 beds. Fifty-eight percent of responding hospitals had fewer than 10 negative pressure isolation rooms, only 36% had more than 10 ventilators, and 55% did not keep a stockpile of antibiotics or antidotes. Although 93% and 98%, respectively, had protocols for canceling elective surgeries and early in-patient discharge, only 64% had plans in place for a mass fatality incident.Conclusion: There are no objective measures of “hospital preparedness” or “hospital surge capacity.” In addition to establishing such standards, focus must be placed on enhancing interagency and interhospital communications. Current numbers of available hospital beds, ventilators, isolation rooms, and pharmaceuticals may be insufficient to effectively care for victims of large-scale disasters and other public health emergencies.

Emergency department disaster preparedness: Are Regional efforts reaching local front lines?

Study objectives: Since the attacks of September 11, 2001, there has been heightened awareness for the possibility of a mass casualty incident (MCI). The Metropolitan Medical Response Systems (MMRS) are one form of targeted funding aimed at improving regional preparedness and response. Although significant progress has been made at the system level during the past 2 years, it is unclear whether these initiatives have filtered down to front-line providers. We choose to assess the impact of MMRS initiatives on emergency department (ED) provider familiarity with and perceptions about disaster preparedness. Methods: A 3-part survey with 30 questions was given to physicians, nurses, and administrators (safety officer/disaster team manager) at Level I and II trauma centers in St Louis, Missouri. Respondents were asked to complete the survey according to their clinical experience. They were asked about disaster preparedness and drills and their institution's ability to handle a number of specific scenarios. Answers were either dichotomous or used a 5-point Likert scale (entirely false to entirely true or unprepared to very prepared). Results: One hundred seventy surveys were returned (50%). Participants included 77 nurses, 65 physicians, 6 administrators, and 22 who did not identify their position. Thirty-eight percent of respondents work in Level I hospitals and 31% in pediatric hospitals. The majority (84%) were aware that their hospital had a disaster or MCI committee. Most (78%) were aware of the existence of the St. Louis MMRS to which their hospitals belong. Fewer (53%) were aware of the mutual aid agreement (signed by all 41 area hospitals 2 years ago) indicating that hospitals will support one another during a disaster (including the sharing of equipment, supplies, and personnel). Of respondents, 43% affirmed that disaster preparedness was part of their employee orientation. Most noted that periodic disaster drills occurred, and 58% said they were familiar with their facility's plan and would be able to carry out their individual portion of it. Although the September 11, 2001, attacks have caused facilities to improve their level of disaster preparedness, less than half of providers thought that the disaster drills being held provided effective training to handle an MCI (41%). However, most believed that holding drills will improve readiness (69%). The vast majority (81%) did not have a working understanding about how MMRS operations would affect their institutions during a disaster. Most ED providers surveyed felt prepared to handle limited local disasters outside the hospital, such as a 4-car highway accident (74%) or food poisoning at a local restaurant (67%). If there were more than 25 patients of mixed acuity, such as tornado hitting nursing home (53%) or protest march (57%), most thought that hospitals would not be able to handle the influx. Most did not feel prepared to handle incidents involving the hospital, such as a fire in central supply (61%) or an earthquake damaging a portion of the building (50%). Despite the attention paid to bioterrorism recently, respondents felt least prepared to handle situations involving nuclear, biological, or chemical agents. Only 22% said they are prepared to deal with an anthrax scare at a local mall with 200 potential victims, and only 35% could handle a tanker derailment with leaking chlorine gas. However, the problem is not only overwhelming numbers of patients; less than 35% of providers felt ready to care for a single smallpox-infected patient. Conclusion: Many ED providers are aware of the heightened concern about disaster preparedness. However, our ability to respond effectively remains limited. Despite more than 2 years of intense work at the regional systems level, most providers, although familiar with MMRS, do not understand its role or likely impact on their institutions during a disaster, such as providing pharmacy caches, sharing supplies between local hospitals, and improving interhospital communication. Staff members are familiar with hospital disaster plans. Although most providers think that disaster drills can improve readiness, they disagree about the effectiveness of current drills to prepare them to handle an MCI.

Transferring patients to a pediatric trauma center: the transferring hospital's perspective.

The rationale behind a regionalized trauma system is that patient outcomes are improved when trauma patients are rapidly transported to facilities with the level of expertise need to treat their injury. Functioning as an adult Level II trauma center, we wanted to know how the transfer process worked for pediatric patients whom we transfer to a Level I pediatric trauma center, which is part of the same multihospital system. Complete information on time of arrival, the time the transfer was accepted, and patient departure time were available for 116 patients (72% of pediatric patients transferred) for the period of January 1, 1997 through June 30, 1998. Patients were retrospectively stratified into two priority groups representing differing transport priority, based on use of a nasogastric tube, endotracheal tube or Foley catheter. Means for decision time and total time in transferring hospital were inspected. Decision time was 44 minutes (standard error 4.5 minutes) for priority patients and 92 minutes (11.5) for non-priority patients (t = 2.94, df = 114, P = 0.004). Total time for priority patients was 129 minutes (7.6) and 197 minutes (14.0) for non-priority patients (t = 3.37, df = 114, P = 0.001). Decision time was not influenced by extensive injury assessment or secondary studies. On average, pediatric patients spent nearly three hours in our facility. Our data indicate that a shorter decision time did not necessarily result in a reduction in wait time. Improving pediatric transfer times requires attention not only to injury assessment processes at the transferring facility and interhospital communications but also mobilization, hand-over, and any space or personnel constraints at the receiving pediatric facility.

9-11 遠隔医療網テストベッドIMPACTを利用したCT画像遠隔診断実験

9-11 遠隔医療網テストベッドIMPACTを利用したCT画像遠隔診断実験

Epidemiological analysis of methicillin-resistant Staphylococcus aureus in a Zagreb Trauma Hospital using a randomly amplified polymorphic DNA-typing method.

During a 1-month period in 1996, all inpatients and staff in the Zagreb Trauma Hospital were screened for methicillin-resistant Staphylococcus aureus (MRSA) carriage in order to control MRSA spread within the hospital. During the study period, 663 patients were admitted to the hospital, and screening prior to discharge revealed that 42 were colonised or infected with MRSA. Twenty-three (55%) of these would not have been detected if active screening had not been performed. Amongst 205 staff members, MRSA carriage was only found in one (0.5%) nurse. The prevalence and incidence of MRSA carriage varied significantly amongst the wards and was related to the length of hospital stay. One-third of the patients colonised or infected with MRSA had a history of previous admission to another hospital, and one-third were transferred to another institution after discharge. Thirty-nine of 42 MRSA isolates shared the same antibiotic sensitivity pattern, suggesting endemic spread of MRSA. However, randomly amplified polymorphic DNA molecular typing revealed four profiles, the most common involving 15 of 36 tested strains. There was no obvious clustering of epidemiological types by ward, except for the appearance of a single type on the burns unit, and it was likely that different strains had been introduced into the hospital by patient transfers from elsewhere. The results of this study indicate that a substantial proportion of MRSA carriers escape infection control measures if active screening is not performed. Based on the results of this study, steps have been taken to improve interhospital communication about the transfer of patients colonised with MRSA. Randomly amplified polymorphic DNA typing proved to be a useful aid to epidemiological investigations of MRSA.

Evaluation of pulsed-field gel electrophoresis and rep-PCR for the epidemiological analysis ofOchrobactrum anthropi strains

Pulsed-field gel electrophoresis and polymerase chain reaction genome fingerprinting based on repetitive chromosomal sequences (rep-PCR) were used for typing 14 strains of Ochrobactrum anthropi. Six strains isolated during an outbreak of bacteraemia in patients who had received a contaminated rabbit anti-thymocyte globulin gave identical patterns by both techniques. Different patterns were found in sporadic and reference strains, except for one clinical isolate received from another hospital that showed the same pattern as the epidemic clone. This patient had also received rabbit anti-thymocyte globulin from the same source at the time of the outbreak. This study illustrates the advantages of genetic typing methods in terms of high typeability and discriminating power, even for rare pathogens. Furthermore, it highlights the need for interhospital communication for effective identification of common sources of outbreaks related to intrinsic drug contamination.

Evolution of hospital communication systems towards multimedia applications

A study of the communication requirements and a detailed analysis of the network infrastructure necessary to efficiently support multimedia applications in a typical mid-range general hospital is presented. The study focuses on the consequences that the introduction of multimedia objects has on existing interconnected networks and has been based on the analysis of the performance of installed interconnected local area networks within a distributed medical database environment. Particular attention has been paid to the problems related to the introduction of multimedia technology in inter-hospital communication systems. The results of a number of tests undertaken in a real-life hospital environment on the transfer of objects simulating multimedia information in interconnected IEEE 802-3 networks are also presented and discussed. Various computational environment scenarios have been considered for this purpose. The operational parameters of the network have been measured in detail. The results obtained and ...

European integrated picture archiving and communication systems, CEC/AIM

A Picture Archiving and Communication Systems, supported by a multi-media medical distributed image data-base, will be integrated with all other components of a Hospital Information System (HIS). Several services will be set up for intra- and inter-hospital communication. A EurIPACS infrastructure will be implemented, validated and demonstrated. Integration and a user driven approach are the key elements: 1. • integrated in a hospital environment stressing the need for having clinical useful systems; 2. • integrated with the other information systems; 3. • the departmental systems; 4. • integrated by means of standards and coordination with CEN TC 251. These key objectives are in stages of pre-prototyping. The first systems are being tested in the labs and prepared for the move to the clinical environment. The implementations will result in a second generation distributed PACS architecture test bed, in '95, installed at several clinical sites in Europe.

A multimedia interhospital communications system for medical consultations

The authors present a study whose main objective has been to explore the use of high-bandwidth multimedia communications technology for medical applications physically distributed among hospitals, that is to say an interhospital multimedia communications system. The design and development issues of a prototype are described, as well as the results of an in-field trial. From the results of this trial, a performance study has been developed for evaluating the expected communications requirements of a large-scale configuration of the system.< <ETX xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">&gt;</ETX>

Prospective Analysis of Rural Interhospital Transfer of Injured Patients to a Referral Trauma Center

A 1-year prospective review of 78 multiply injured patients initially treated at local community hospitals and subsequently transported more than 25 miles to a referral trauma center was completed. Injury mechanisms were blunt in 74 (95%) patients and penetrating in four. Patient ages ranged from 6 to 88 years (mean, 33 years). Trauma Scores ranged from 6 to 16 (mean, 13.9) and Injury Severity Scores ranged from 4 to 54 (mean, 21.5). The quality of care during initial stabilization and transport was evaluated by ATLS guidelines for airway management, treatment of shock, spine and fracture immobilization, neurologic evaluation, secondary assessment, and chart documentation. Most frequent departures from these standards involved failure to place a nasogastric tube before transport (72%), failure to document neurologic status (47%), inadequate cervical spine immobilization (32%), inadequate intravenous access (29%), inadequate oxygen delivery (28%), and incomplete or absent records (22%). Life-threatening deficiencies were identified in four (5%) patients and serious deficiencies in 62 (80%). This study demonstrates the need for further education of rural physicians about priorities in trauma management. Increased emphasis on stabilization and transport should be added to ATLS training courses. Established transport protocols between institutions would enhance the quality of care and engender improved interhospital communication. The implementation of trauma systems designed specifically for rural areas must be supported.

Effect of a new computed tomographic image transfer system on management of referrals to a regional neurosurgical service

A computed tomographic image transfer system ('Image Link') was used to link scanners within the Oxford region, UK, to the regional neurosurgical service. 100 consecutive neurosurgical referrals were examined by this system; 43% of the emergency referrals did not require transfer, 31% were transferred electively, and 26% urgently. Most of the patients defined as potentially hazardous for transfer (10/11) did not require neurosurgical intervention. The delay by the use of the system was negligible and early detection of intracranial haematoma contributed to good outcome in some head injured patients. Overall, 3,170 miles of ambulance journey were avoided. Use of image link has led to substantial improvements in management of neurosurgical emergency referrals, cost-effectiveness of neurosurgical and ambulance facilities, and interhospital communication between doctors.