Introudction: Suboptimal care transition post-discharge may potentially increase subsequent healthcare system utilization. Transition of care is a service approach to support continuum of patient care after discharge. Objectives: This study aimed to compare the effect of pharmacist-assisted transition of care versus standard care models towards healthcare resource utilization among medical ward patients. Methods: A cluster randomized controlled study was conducted among medical ward patients in a Malaysian secondary hospital from July to December 2019. Intervention group received pharmacist-assisted discharge medication reconciliation, bedside discharge medication delivery with counselling and a timely post-discharge callback. Control group followed standard discharge process with medication collection at ambulatory pharmacy without post-discharge phone calls. Study endpoints included pharmacy first refill persistency, resolution on unintended discharge medication discrepancies and 30-days all-cause rehospitalization. Results: A total of 168 patients with 84 patients in each arm were recruited. Intervention resulted a higher pharmacy first refill persistency (70.2% versus 50.0%, p<0.05), indicating a lowering in subsequent unscheduled refill rate. Under intervention, consistent rate of resolution from discrepancies (100.0%, IQR 0 versus 100.0%, IQR 67; p<0.05) was demonstrated that corresponded to medication cost-savings of RM6.80 per prescription over control. Unplanned rehospitalization was not significantly different between groups (p>0.05) but towards a trend of 10% reduction after intervention. Conclusion Pharmacist-led transition care model demonstrated promising effect towards a reduction in healthcare resource use compared to standard care. Future studies for its standardization across institutions are warranted to facilitate service expansion.
Patient Transfer

Several studies have reported adequate patient transfer to higher level hospitals according to the risk for improving perinatal outcomes. According to these reports, countries across the world divide the levels of maternal care on the basis of the assessment of hospital facilities and medical services as well as the assessment of high-risk pregnancies while evaluating the cases of and risks associated with maternal care that can be addressed by these hospitals at each level. Because the level of and policies on maternal care vary across countries, we aimed to evaluate risk assessments and introduction of treatment facility classifications in different countries. In Korea, birth rate is declining and the number of elderly pregnant women is increasing, whereas the number of hospitals that can deliver a baby and care for mothers at high risk is decreasing. We, therefore, need to establish an infrastructure for medically vulnerable areas, a localization center, and a medical personnel supplement. Moreover, establishing detailed guidelines and criteria for different levels of maternal care is necessary. The new guidelines will also need to supplement the policies on the requirement of well-trained obstetricians and of low medical insurance fee.
Aged ; Birth Rate ; Classification ; Fees and Charges ; Female ; Humans ; Insurance ; Korea ; Maternal-Child Health Services ; Mothers ; Patient Transfer ; Pregnancy, High-Risk ; Pregnant Women ; Prenatal Care ; Risk Assessment

BACKGROUND: Selecting the appropriate patients and reducing stroke onset to endovascular recanalization therapy (ERT) time are essential elements of a successful ERT. Since ERT is available only in large hospitals, proper patients transfer is important. The purpose of study is to examine the suitability of the transfer of acute stroke patients. METHODS: We retrospectively reviewed the medical records of patients who diagnosed as acute ischemic stroke from January to December in 2017. Patients were divided into two groups based on transfer (direct visit vs. transfer) and Alberta Stroke Program Early computed tomography (ASPECT) score (≥8 vs. <8) respectively. Each group was assessed by demographics, type and rate of reperfusion therapy, onset to reperfusion therapy time, stroke risk factors and neurological deficit severity. Interhospital distance and transfer time was calculated in transferred patients. RESULTS: Among the 455 patients, the 228 (50.2%) patients underwent interhospital transfer. The ratio of reperfusion therapy was not significant different between direct visit and transferred group (34.8% vs. 37.3%, p=0.397). The transferred patients tended to be older (p=0.003), female (p=0.001), more hypertension (p=0.019), less transient ischemic attack (p=0.001), longer onset to ERT time (178.55±85.92 vs. 131.48±82.89; p=0.001) lower ASPECT score (6.72±2.04 vs. 8.01±1.65; p<0.001) and higher National Institute of Health Stroke Scale (NIHSS) (p<0.001) and modified Rankin Scale (mRS) (p<0.001). High ASPECT score (≥8) patients were more direct visited (63.9%), shorter onset to ERT time (p=0.047), lower initial NIHSS and mRS (p<0.001), and greater in differences between mRS at admission and 3 months later (p=0.016). CONCLUSIONS: This study suggests emergency and interhospital transfer of acute stroke patients is inefficient, and systematization of transfer is necessary.
Alberta ; Demography ; Emergencies ; Endovascular Procedures ; Female ; Humans ; Hypertension ; Ischemic Attack, Transient ; Medical Records ; Neuroimaging ; Patient Transfer ; Reperfusion ; Retrospective Studies ; Risk Factors ; Stroke

Background: Non-communicable diseases (NCDs) such as hypertension and diabetes mellitus, which are mainly primary care conditions, are ideally managed in local health centers (LHCs). However, majority of patients with NCDs utilize tertiary hospitals. Objectives: To determine factors associated with willingness of patients with NCDs consulting at the UP-PGH Family Medicine Clinic (FMC), a hospital-based primary care clinic, to transfer medical care to local health centers. Methods: A cross-sectional study using a 5-part, interview-assisted questionnaire was conducted among 380 patients with hypertension and/or diabetes mellitus. Data were analyzed using SPSS and STATA. Results: Respondents had a low degree of willingness to transfer medical care to health centers at 32% (SD ± 21). Significant predictors include being married, presence of hypertension, PhilHealth coverage, satisfaction with waiting time and perception of appropriate service delivery at FMC. Conclusion Patients with NCDs consulting at FMC had low willingness to transfer to local health centers. Moreover, there was low utilization of local health centers despite awareness of presence of LHCs in the community. Almost all viewed that NCDs are best managed in a hospital-based outpatient clinic rather than the health center, consistent with perceptions of higher quality of service delivery and higher service satisfaction in the FMC. Sociodemographic, economic and health system factors were identified to affect willingness to transfer.
Primary Health Care ; Patient Transfer ; Health Facilities ; Patient Preference ; Noncommunicable Diseases

In daily medical work, most of the critically ill patients who cannot move by themselves are pulled and lifted by manpower, often relying on the cooperation of many doctors and nurses, which not only increases the risk of transfer and patients' discomfort, but also causes certain skeletal and muscle damage to the porters. The emergency department of the First Hospital of Jiaxing City, Zhejiang Province designed a kind of patient transfer device, and obtained the National Utility Model Patent (ZL 2018 2 0579844.X). The transfer device is composed of upper frame, lower frame and base. The upper frame and the lower frame are rectangular and in a horizontal position. The upper frame can slide laterally through the circular tubes which are fixed on the lower frame. The lower part of the base is provided with four universal foot brake wheels. During the usage, the booster frame facilitates the transfer of patients by the rolling and two sliding tracks of the circular tube, which can make patients move smoothly and comfortably, and reduce the working intensity of the transporter. This device has good practical value.
Critical Illness ; Emergency Service, Hospital ; Humans ; Patient Transfer/methods*

The total fertility rate in South Korea is one of the lowest among the Organisation for Economic Co-operation and Development (OECD) countries. However, the number of advanced maternal age and high risk pregnancies are rising due to delays in marriage and increased infertility rates, resulting in a maternal mortality rate that is higher than the OECD average. The most common cause of maternal mortality has been reported to be obstetric embolism, followed by postpartum hemorrhage. Hemorrhage is a preventable condition that can be solved by expeditious initial management such as transfusion, medication, and prompt transfers to tertiary centers that are capable of managing obstetric emergencies. However, the number of maternity care hospitals in underserved areas has been falling since 2004 due to business losses stemming from low birth rates, inadequate insurance payments for obstetric services, and the shortage of obstetricians. The insufficient maternity care system for high risk pregnant women in Korea has also led to an increase in maternal mortality. Therefore, the Ministry of Health and Welfare has supported the establishment of an ‘Integrated Care Center for High Risk Pregnancy and Neonate’ for high risk maternity and neonatal cases. However, there is no systematic transfer system in place to monitor and support emergency patient transfers in the event of obstetric emergencies. Although the Disaster & Emergency Medical Operations Center is currently carrying out these tasks, it is insufficient to properly manage all obstetric transfers. Our plan is to establish an Emergency Maternal Transport Control Center that is linked with the existing Disaster & Emergency Medical Operations Center at the National Medical Center. To implement this system, cooperation from each maternity and neonatal center will be crucial to share available human and material resources. Successful implementation of this system will allow for communication not only with the regional perinatal centers, but on a nationwide scale to detect and conduct necessary transfers of high risk pregnancy patients in emergency situations. It is anticipated that this system will significantly improve maternal health care as well as obstetric infrastructure, especially in underserved areas.
Accidental Falls ; Birth Rate ; Commerce ; Disasters ; Embolism ; Emergencies ; Female ; Hemorrhage ; Humans ; Infertility ; Insurance ; Korea ; Marriage ; Maternal Age ; Maternal Health ; Maternal Mortality ; Organisation for Economic Co-Operation and Development ; Patient Transfer ; Postpartum Hemorrhage ; Pregnancy ; Pregnancy, High-Risk ; Pregnant Women

OBJECTIVE: This study aimed to achieve expert consensus for the development of strategies emergency medical services system (EMSS) after reunification of Korean using the Delphi method. METHODS: The Delphi study was performed through several rounds from January to February in 2017. Experts who have experiences of emergency medical support in North Korea and developing countries participated in the study. Respondents were asked to express their level of agreement following 7 categories: (1) emergency medical manpower, (2) communication system, (3) emergency facilities, (4) patient transfer system, (5) consumer participation and public education, (6) insurance system, (7) disaster planning. Score 1–3 was classified as disagreement, 4–6 as medium agreement, and 7–9 as agreement and consensus was considered being achieved when more than two thirds of respondents agreed in each question. RESULTS: Response rate were 80% in the first round and 75% in the second round. Consensus was achieved in emergency medical manpower, communication system, emergency facilities, patient transfer system, and disaster planning for the important factors immediately after reunification within 5 years. Consensus was achieved in emergency medical manpower, communication system, emergency facilities, patient transfer system, consumer participation and public education, and disaster planning for the prior factors when the reunification would happen rapidly without enough preparation. CONCLUSION: Consensus was achieved in emergency medical manpower, communication system, emergency facilities, patient transfer system, disaster planning for the essential EMSS elements. The consensus was expected to utilize as a basic data for the development of EMSS preparing for reunification.
Consensus* ; Consumer Participation ; Delphi Technique* ; Democratic People's Republic of Korea ; Developing Countries ; Disaster Planning ; Education ; Emergencies* ; Emergency Medical Services* ; Expert Testimony ; Insurance ; Korea* ; Methods ; Patient Transfer ; Public Health ; Surveys and Questionnaires

OBJECTIVE: Regionalization is one of the principal subjects for the advancement of rural emergency medical service systems in South Korea. This study shows the characteristics of interhospital transfer and status of the incidence of three major emergency disorders (acute myocardial infarction [AMI], acute stroke, and severe trauma) in one local province. METHODS: A retrospective study was conducted for patients with three major emergency disorders who visited emergency medical facilities in one local province from January 2013 to December 2015, on the basis of the National Emergency Department Information System (NEDIS) data. RESULTS: The incidence of three major emergency disorders had increased annually. Patients with each of these disorders tended to choose distinguishing methods of visiting emergency medical facilities. AMI patients tended to visited emergency medical facilities using private cars or on foot, while severe trauma patients usually visited by 119 ambulance, and acute stroke patients used 119 ambulance and private car in similar amounts. Overall, 65% of AMI patients were treated in intraregional medical facilities, but about 70% of acute stoke and severe trauma patients were transferred outside of the region. CONCLUSION: Because each of these disorders has an individual characteristic, it is difficult to expect a solution for the problems associated with emergency disorders just by assuring the availability of medical resources. Based on regionalization, a policy to provide the optimal treatment for those emergency disorders should be developed by planning public medical service systems based on the individual characteristics of emergency disorders, the standardized transfer plans of emergency patients and the assurance for mobilization and sharing of confined medical resources.
Ambulances ; Chungcheongnam-do* ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Foot ; Humans ; Incidence ; Information Systems ; Korea ; Myocardial Infarction ; Patient Transfer ; Retrospective Studies ; Stroke

PURPOSE: This study aimed to construct a management model for patient transfer in a multilevel healthcare system and to predict the effect of counseling with nurses on the patient transfer process. METHODS: Data were collected from the electronic medical records of 20,400 patients using the referral system in a tertiary hospital in Seoul from May 2015 to April 2017. The data were analyzed using system dynamics methodology. RESULTS: The rates of patients who were referred to a tertiary hospital, continued treatment, and were terminated treatment at a tertiary hospital were affected by the management fee and nursing staffing in a referral center that provided patient transfer counseling. Nursing staffing in a referral center had direct influence on the range of increase or decrease in the rates, whereas the management fee had direct influence on time. They were nonlinear relations that converged the value within a certain period. CONCLUSION: The management fee and nursing staffing in a referral center affect patient transfer counseling, and can improve the patient transfer process. Our findings suggest that nurses play an important role in ensuring smooth transitions between clinics and hospitals.
Continuity of Patient Care ; Counseling* ; Delivery of Health Care ; Electronic Health Records ; Fees and Charges ; Humans ; Nursing ; Patient Transfer* ; Referral and Consultation ; Seoul ; Tertiary Care Centers

OBJECTIVE: This study compared the prognosis of patients who visited the trauma center directly (direct visit group) with those transferred from the non-trauma center (transferred group). METHODS: The patients, who were 18 or older with Injury Severity Score of 15 or more in the trauma center at Busan, were studied from October 2015 to October 2016. To compare the treatment time between the direct visit and transferred group, first treatment time, final treatment time, and time to visit the trauma center were examined. To compare the prognosis, this study compared the 48-hour, 7-day, and in-hospital mortality rate as well as the duration of intensive care unit (ICU) and total hospital stay. To analyze the factors affecting the outcome of transferred group, the physician's level and procedures that had been performed at the non-trauma center were examined. RESULTS: The mortality was similar in the direct visit and transferred group (48-hour 7.6% vs. 4.6%, P=0.111; 7-day 11.1% vs. 7.2%, P=0.89; and in-hospital 14.6% vs. 11.3%, P=0.214). The length of ICU and total hospital stay were similar in the two groups. The mortality was higher in the patients in the transferred group when using intubation, transfusion, and pressure intensifier. The intubated patients showed higher mortality according to logistic regression. CONCLUSION: The mortality, length of ICU, and hospital stay were similar but the time to visit the trauma center and the final treatment time were longer in transferred group. Stabilizing the patient at the near non-trauma center may be more helpful for some patients.
Busan ; Hospital Mortality ; Humans ; Injury Severity Score ; Intensive Care Units ; Intubation ; Length of Stay ; Logistic Models ; Mortality ; Patient Transfer ; Prognosis ; Trauma Centers