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Original Research

Open Access

Quality of inter-facility transfer for Type A aortic dissection patients in a medical center in Taiwan: a retrospective observational study

  • Shang-Li Tsai1,2
  • Chip-Jin Ng1,2,3
  • Ming-Fang Wang1
  • Chi-Chun Lin1,4
  • Chen-Bin Chen1,5
  • Chien-Hsiung Huang1,6,7,†
  • Li-Heng Tsai1,†
  • Cheng-Yu Chien1,2,4,8,9,*,†,

1Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan

2Department of Emergency Medicine, Chang Gung Memorial Hospital Taipei Branch, 105 Taipei, Taiwan

3Department of Nursing, Chang Gung University of Science and Technology, 333 Taoyuan, Taiwan

4Department of Emergency Medicine, Ton-Yen General Hospital, 302 Zhubei, Taiwan

5Department of Emergency Medicine, New Taipei Municipal TuCheng Hospital and Chang Gung University, 236 New Taipei City, Taiwan

6Graduate Institute of Management, College of Management, Chang Gung University, 333 Taoyuan, Taiwan

7Department of Emergency Medicine, New Taipei City Hospital, 241 New Taipei City, Taiwan

8Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, 100 Taipei, Taiwan

9Department of Senior Service Industry Management, Minghsin University of Science and Technology, 304 Hsinchu, Taiwan

DOI: 10.22514/sv.2024.027 Vol.20,Issue 3,March 2024 pp.46-53

Submitted: 26 October 2023 Accepted: 24 November 2023

Published: 08 March 2024

*Corresponding Author(s): Cheng-Yu Chien E-mail: b8902019@cgmh.org.tw

† These authors contributed equally.

Abstract

Inter-facility transfer of patients with type A aortic dissection (AD) requires timely and efficient medical care. However, the quality of care provided during the transfer remains largely unknown. This study aimed to evaluate the quality of care of patients with type A AD who underwent inter-facility transfer at a single medical center in Taiwan. This retrospective cohort study enrolled all patients with type A AD who underwent inter-facility transfer between January 2017 and December 2019. Patients with complete transfer records and electronic medical charts in the emergency department (ED) were included. Patients who experienced a cardiac arrest episode before transfer were excluded due to poor outcomes. Patients were divided into two groups based on their hemodynamic status: the ideal group with values within the desirable range heart rate (HR) <60 bpm and systolic blood pressure (SBP): 100–120 mmHg and the control group with values out of range (HR >60 bpm or SBP <100 or >120 mmHg) before the transfer. We conducted an analysis of variations of hemodynamic status after the transfer. Among the 378 patients transferred with type A AD, 36 (31.9%) in the ideal group and 255 (96.2%) in the control group experienced hemodynamic deterioration after the transfer. In the ideal group and control group, the presence of nurses and emergency physicians assisting in the transfer accounted for only 6.2% and 7.95%, respectively. The ideal group had a significantly better survival outcome (adjusted OR (aOR): 1.25, 95%confidence interval (CI): 1.12–2.45) compared to the control group. The quality of inter-facility transfer in patients with type A AD is inadequate. Hemodynamic deterioration should be managed by ambulance crews during the transfer.


Keywords

Type A aortic dissection; Emergency department; Transfer safety; Inter-facility transfer


Cite and Share

Shang-Li Tsai,Chip-Jin Ng,Ming-Fang Wang,Chi-Chun Lin,Chen-Bin Chen,Chien-Hsiung Huang,Li-Heng Tsai,Cheng-Yu Chien. Quality of inter-facility transfer for Type A aortic dissection patients in a medical center in Taiwan: a retrospective observational study. Signa Vitae. 2024. 20(3);46-53.

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