Effect of a prioritization score on the inter-hospital transfer time management of severe COVID-19 patients: a quasi-experimental intervention study

Abstract

Background The overburdening of the health care system during the COVID-19 pandemic is driving the need to create new tools to improve the management of inter-hospital transport for patients with a severe COVID-19 infection. The aim of this study was to analyse the usefulness of the application of a prioritisation score (IHTCOVID19) for inter-hospital transport in patients with severe COVID-19. Methods The study has a quasi-experimental design and was conducted on the Medical Emergency System, the prehospital emergency department of the public company belonging to the Autonomous Government of Catalonia that manages urgent healthcare in the region. Patients with severe COVID-19 infection requiring inter-hospital transport were consecutively included. The pre-intervention period was from 1 to 31 March 2020 and the intervention period with the IHTCOVID19 score was from 1 to 30 April 2020 (from 8 am to 8 pm). The prioritisation score comprises four priority categories, with Priority 0 being the highest and 3 the lowest. Inter-hospital transfer management times (alert-assignment time, resource management time and total central management time) and their variability were evaluated according to whether or not the IHTCOVID19 score was applied. Results A total of 344 inter-hospital transfers were included, 189 (54.9%) in the pre-intervention period and 155 (45.1%) in the post-intervention period. The majority of patients were male and the most frequent age range was between 50 and 70 years. According to the IHTCOVID19 score, 12 (3.5%) transfers were classified as Priority 0, 66 (19.4%) as Priority 1, 247 (71.8%) as Priority 2 and 19 (5.6%) as Priority 3. Overall, with the application of the IHTCOVID19 score, there was a significant reduction in total central management time [from 112.4 minutes (IQR 281.3) to 89.8 (IQR 154.9); p=0.012]. This significant reduction was observed in Priority 0 patients [286.2 minutes (IQR 218.5) to 42.0 (IQR 58); p=0.018] and Priority 1 patients [130.3 minutes (IQR 297.3) to 75.4 (IQR 91.1); p=0.034]. After applying the IHTCOVID-19 score, the average time of the process decreased by 22.6 minutes and variability was reduced from 618.1 min to 324.0 minutes. Conclusion The application of the IHTCOVID19 score in patients with a severe COVID19 infection reduces inter-hospital transfer management times and variability.

A Context-Aware Framework to Manage the Priority of Injured Persons Arriving at Emergencies

“…However, it is important to consider factors such as data security and privacy and the potential for bias in the algorithms used to analyze patient data. [25] ü  ü ü  ü ü The objectives of the work are to develop a smart system for predicting patient context, collecting data, and triggering emergency alerts. The system includes a real-time ontology-based data model with an emergency mechanism for locating patients and notifying the nearest hospital.…”

Experiences of Inter-Hospital Transfers (IHT) by Patients and Relatives during the COVID-19 Pandemic in France: A Qualitative Study

“…During the COVID-19 crisis, questions concerning transfers focused on the ethical dilemmas of sorting patients, and their capacities to withstand them, leading to the development of tools evaluating the indications for transfer. Although studies are beginning to emerge in the literature concerning the prioritization score for inter-hospital transfer [7] or the experience of caregivers [8], the subjective experience of patients and their relatives has not yet been evaluated to our knowledge. This evaluation seems even more necessary, as the context of care in the ICU is known to cause psychological disorders, both in patients and in their relatives.…”