ABSTRACT
Organizing interfacility transfers is an essential component of regionalized care to improve patient outcomes. This study examines transfer characteristics after establishing a transfer center in a tertiary care center in Beirut Lebanon, and identifies predictors of success in patient transfers.This retrospective observational chart review examined all transfer center requests to and from the tertiary care center over a 4-year period (2013-2017). Descriptive analysis was done, followed by a bivariate analysis comparing transfers based on final decision (accepted yes/no) and by a multivariate logistic regression to identify predictors of successful transfers.A total of 4100 transfer requests were analyzed. Incoming transfer requests were more common than outgoing requests (56.5% vs 43.4%) and were mainly for adult patients (71.0% incoming and 78.7% outgoing). Reasons of transfers were mostly medical (99.4%) for incoming transfers and financial (73.1%) and medical (17.9%) for outgoing transfers. Requested level of care was most commonly intensive care unit for incoming transfers (61.6%) and regular floor for outgoing transfers (48.6%). Outgoing transfers were more successful than incoming transfers (59.9% vs 39.6%). Predictors of success in patient transfers within the healthcare system were identified: These included specific types of financial coverage, diagnoses, levels of care, and medical services for incoming transfers in addition to age groups and receiving hospital location for outgoing transfers.Transfer centers can be implemented successfully in any healthcare system to improve patient care and safety. Identifying facilitators and barriers to successful transfers can help healthcare administrators and policymakers address gaps in the system and improve access to care.
Subject(s)
Emergency Medical Services/standards , Patient Safety , Patient Transfer/standards , Tertiary Care Centers , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Emergency Medical Services/economics , Emergency Medical Services/statistics & numerical data , Female , Humans , Infant , Infant, Newborn , Lebanon/epidemiology , Male , Middle Aged , Organizational Culture , Patient Transfer/economics , Patient Transfer/statistics & numerical data , Quality Improvement , Retrospective Studies , Young AdultABSTRACT
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is used to evaluate the performance of the emergency medical service (EMS) system. Our study examined the characteristics and outcomes of OHCA cases presenting to a tertiary care center in Beirut, Lebanon. METHODS: A retrospective chart review of all adult OHCA patients admitted to the emergency department (ED) over a 3-year period was carried out. Data collection and analysis was performed using the Utstein guidelines. RESULTS: A total of 214 OHCA patients were presumed to have cardiac etiology; of them 205 (95.8%) underwent ED resuscitation. The mean age was 69±15.4 years. More than half of the patients (54.2%) were witnessed, but unfortunately the bystander cardiopulmonary resuscitation rate was low (4.2%). Most of them were transported by EMS (71.5%). An automatic external defibrillator was rarely used (0.9%). Asystole was the predominant presenting rhythm in ED (81.8%). Eleven patients (5.5%) survived to hospital discharge and five (45.4%) had good neurological outcome. CONCLUSION: The OHCA survival rate in Beirut, Lebanon, is low. Bystander cardiopulmonary resuscitation and early defibrillation should be prioritized to achieve better outcomes.
Subject(s)
Out-of-Hospital Cardiac Arrest/mortality , Aged , Emergency Service, Hospital/standards , Emergency Service, Hospital/statistics & numerical data , Humans , Lebanon/epidemiology , Male , Out-of-Hospital Cardiac Arrest/epidemiology , Out-of-Hospital Cardiac Arrest/therapy , Resuscitation/statistics & numerical data , Retrospective Studies , Survival AnalysisABSTRACT
BACKGROUND: To introduce the 2-incision technique for laparoscopic adjustable gastric banding (LAGB) and report our experience with 25 consecutive patients. Newer applications of minimally invasive laparoscopic techniques have been touted as revolutionary. METHODS: We have introduced a technique for LAGB that uses 2 skin incisions: 1 incision in the right upper quadrant (2.5 cm) that accommodates 2 trocars (11 and 5 mm) through which the dissection and implantation of the band were undertaken, and a 0.5-cm incision in the left upper quadrant for the 5-mm videoscope. The band reservoir was placed in a subcutaneous pocket through the upper quadrant incision. Previously, we used a standard 5-incision technique: 2 in the right upper quadrant, 2 in the left paramedian, and 1 in the subxyphoid area to retract the liver. The data from 25 consecutive 2-incision LAGB procedures (October 2007 to April 2008) were compared with the data from 19 consecutive standard 5-incision LAGB procedures (July 2007 to October 2007). The data are presented as mean +/- SD. The t test was used to compare the mean values, and P <.05 was considered significant. RESULTS: The mean estimated blood loss in the 2-incision LAGB was 54 +/- 2 mL compared with 17 +/- 1 mL in the standard technique (P = .040). The mean operating time for the 2-incision LAGB was 119 +/- 1 minutes compared with 103 +/- 1 minutes for the standard technique (P = .047). No mortality or procedure-related complications (e.g., erosion, slippage) occurred in the 2 groups. CONCLUSION: Two-incision LAGB is feasible; however, it is associated with an increased operating time and blood loss. The operating time and blood loss might improve with standardization of the operative technique and introduction of newly designed flexible tip instruments. Additional prospective studies with a larger sample size are needed to assess the efficacy and benefit of the 2-incision technique versus the standard technique.
