The distribution of emergency service patients according to the World Health Organization

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Aim: The objective of this research is to evaluate the emergency of the patients coming to the emergency service of Sivas Turkish Hospital by grouping them according to the World Health Organization’s (WHO) 32 emergency parameters. Material and Method: Sivas Turkish Hospital patients that were brought in by an emergency ambulance were grouped according to the WH O’s 32 parameters by the data on their computer registries. Also, according to the age, gender, and hospitalization status of each patient, a second grouping was performed. Results: 34.2% (n = 205) of emergency patients were evaluated as urgent. These patients were grouped according to 32 WHO parameters. The gender of the patient was not related to the emergency. The urgent cases requiring admission were the elderly and those with social security. Discussion: We saw that ambulance requirement was not essential in most cases. As patients are unaware of their situation, their knowledge of emergency service treatment needs to be expanded.

Introduction

Emergency health services are pre-hospital outpatient extensions for emergency health care. The concept of transporting patients and injured to the health care extends to ancient Roman times. However, the basis of emergency medical services, as we know it nowadays, have been taken in administrative and clinical developments in the 1060s and 1970s [1].

Vehicles used for patient transport may be land ambulances, helicopters, aircraft ambulances, or various emergency response vehicles (fire or police vehicles). The land ambulance is the most commonly used tool in the field [1]. All of the patients brought to the emergency department of Sivas Turkish Hospital were brought in by a land ambulance.

Patients brought to Sivas Turkish Hospital are delivered to the emergency service from a different entrance door from distant patients. The records of the patient are registered at the same time. This study benefited from these records.

Emergency departments are easily accessible units at the entrance of the hospital where 24-hour uninterrupted medical services are provided. Variables such as special conditions, insurance, and social security institution payment criteria can play a role in the application except for the medical requirement, depending on the patient and social situation. Without focusing on these variables, careful evaluation of each hospitalized emergency patient is expected [2,3,4]. Improper use of this immediate health care is obvious. Similar inappropriate use for emergency ambulance system is valid. It is unexpected that all ambulance calls are made for situations that life-threatening [2, 3].

In this study, it is aimed to have an understanding of whether the patients who came with the ambulance were urgent or not and the grouping of the urgent cases according to World Health Organization criteria was done.

Material and Method

The study is carried out in the emergency service of Sivas Turkish Hospital and between June and July of 2017. A total of 600 patients were evaluated retrospectively. The emergency medical records of the patients and the International Classification of Diseases-10 (ICD-10) diagnostic codes were examined and grouped according to the World Health Organization’s 32 emergency parameters [2]. A chi-square test was used as a statistical analysis test. In the evaluation of the data, the p value found to be less than 0.05, was considered statistically significant.

Of the 600 patients who came with an ambulance, 329 (54.8%) were male, 61-80 were the most frequent age group (26.7%), and 567 (94.5%) of them were made suggestions to and given prescriptions. 578 (96.3%) patients were transferred from the city center, and 491 (81.8%) of the patients were evaluated as non-judicial. 205 (34.2%) patients were accepted as emergency cases according to the WHO’s 32 emergency parameters. 86 (14.3%) of these cases were traffic accidents, and according to WHO’s 32 emergency parameters, the most cases are in this group.

Among the oldest group 81-100 (n = 54, 9%), myocardial infarction was the most common illness. The second one that we commonly come across with the same group is the asthma crisis. Patients in the 61-80 age group (n = 157, 26.2%), who were the most to visit emergency services, came to our hospital mostly with myocardial infarction and asthma attack, successively. Most of the hospitalized patients were male (n = 19, 63.3%) in 61-80 age group (n = 14, 46.7%) with myocardial infarction (n = 12, 40.0%). Urgency rate was higher in the patients coming from the city center (n = 374, 94.7%) compared to the patient coming from district centers (n = 21, 5.3%).

16.7% (n = 5) of the patients who came to the emergency center from the district center and 83.3% (n = 25) of those who came from the city center were lying. The number of emergency patients was found to be significantly higher in the center according to the province (p = 0.003).

Patients between the ages of 81 and 100 and patients between the ages of 61 and 80 mostly suffered from the myocardial infarction group diseases. Patients between the ages of 21-40 and 41-60 were urgent because of the traffic accidents.

Discussion

Transportation to the hospital with an ambulance is the most important part of the pre-hospital health service. Transfer between hospitals takes place again with ambulances. The most important feature of today’s ambulances is that it allows the health personnel to perform necessary airway and breathing attempts while transporting the patient safely.

Female gender is higher among emergency patients, while male gender is higher in ambulance patients. It is reported in the literature that men seek higher ambulance use and pre-hospital emergency medical services. However, our data are insufficient to explain this phenomenon scientifically [5,6-9]. In our study, male gender applied more urgently with an ambulance. In the study of Atilla and colleagues, geriatric patients used ambulances more [5]. The same results have been achieved in our study. High discharge rates of ambulance patients are reported as one of the criteria for inappropriate use of ambulances, according to a meta-analysis by Snooks et al. [5,10]. Despite the different criteria used in this meta-analysis, inappropriate use rates were found to be 34-51% in the UK, 42% in Canada, 11% in New York and 30% in Baltimore [5,10]. Atilla and his colleagues found this rate to be 70% [5]. In our study, there was more inappropriate use rate than other studies, and the rate was 94.5%.

Considering all agreement to the Kaldırım and colleagues’ study, 37.95% (n = 837) of patients who complain of geriatric illness were really geriatric patients [11]. In our study, geriatric patients were more hospitalized than others.  In the study of the Yaylacı and friends, 62.3% (n = 71) of the patients complied with WHO-designated international admissions and 32 emergency conditions. 37.7% (n = 43) of the applications were not considered urgent according to the same parameters. 36.8% (n = 26) of the cases were trauma, 16.9% (n = 12) infectious causes, 16.9% (n = 12) neurological emergencies and 15.4% of the cases (N = 11) have cardiovascular emergencies [2]. In our study, 34.2% (n = 235) was accepted as urgent according to WHO’s 32 emergency parameters. With 14.3% (n = 86) the majority of emergency cases were traffic accidents. In the study of the Yaylacı and his colleagues, 15.8% (n = 18) of asthma were recorded as forensic cases. In our study, 18.2% (n = 109) cases were judged to be judicial. The rate of forensic cases is parallel to the literature.

The most frequent patient group was elderly patients. The cardiac and respiratory problems encountered in this patient group are parallel to the literature. Traffic accidents are the most common group of cases, and the results may be deceptive because the research covers the patients in spring and summer. Patient education will be beneficial for the optimal use of emergency facilities and ambulance because the majority of patients coming to the emergency room with an ambulance are non-emergency patients.

Acknowledgement:

The review of this article was made by Medine Koçkanat.

Funding:

There was no need to have financial support for this study and thereby no funders were needed.

Competing interests:

The author declares that he has no competing interests.

References

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2. Yaylacı S, Öztürk TC, Yılmazer SÇ. Acil Servise Ambulansla Başvuran Hastaların Aciliyetinin Retrospektif Değerlendirilmesi. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi. 2013; 2 (2):64-7. (Turkish)

3. Morgans A, Burgess S. Judging a patient’s decision to seek emergency healthcare: clues for managing increasing patient demand. Aust Health Rev. 2012; 36: 110-4.
4. Oktay C, Çete Y, Eray O, Pekdemir M, Günerli A. Appropriateness of Emergency Department Visits in a Turkish University Hospital. Croat Med J. 2003; 44: 585-91.

5. Atilla Ö, Oray D, Akın Ş, Acar K, Bilge A. An Emergency Department perspective: Ambulance transfers and referral consents of the patients. Türkiye Acil Tıp Dergisi. 2010; 10(4): 175-80.

6. Keskinoglu P, Sofuoglu T, Ozmen O, Gündüz M, Ozkan M. Older people’s use of pre-hospital emergency medical services in Izmir, Turkey. Arch Gerontol Geriat. 2010; 50: 356-60.

7. Burt CW, McCaig LF, Valverde RH. Analysis of ambulance transports and diversions among US emergency departments. Ann Emerg Med. 2006; 47: 317-26.
8. Marinovich A, Aflalo J, Aflalo M, Colacone A, Unger B, Giguère C, et al. Impact of ambulance transportation on resource use in the emergency department. Acad Emerg Med. 2004;11.

9. Kawakami C, Ohshige K, Kubota K, Tochikubo O. Influence of socioeconomic factors on medically unnecessary ambulance calls. Bmv health serv res. 2007; 7: 120.

10. Snooks H, Wrigley H, George S, Thomas E, Smith H, GlasperA. Appropriateness of use of emergency ambulances. J Accid Emerg Med. 1998; 15: 212-5.

11. Kaldırım Ü, Tuncer SK, Ardıç Ş, Tezel O, Eyi Ye, Arzıman İ. Türkiye Acil Tıp Dergisi (Tr J Emerg Med). 2013; 13(4): 161-5.

Additional Info

  • Recieved: 10.07.2017
  • Accepted: 25.07.2017
  • Published Online: 25.07.2017
  • Printed: 01.11.2017
  • DOI: 10.4328/JCAM.5212
  • Author: Serkan Kockanat
  • Identifier: J Clin Anal Med. 2017;8(6):474-477
  • Index Page: 474-477
  • How to Cite: Serkan Kockanat. The distribution of emergency service patients according to the World Health Organization. J Clin Anal Med. 2017;8(6):474-477
  • Running Title: Emergent cases
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