The Improvement of Trauma Patients Referral System, Surin Province

Abstract

Background: According to Surin Hospital's trauma surveillance record analysis in 2004, there were 20,912 trauma patients, 16,466 of these were referred from 13 communities hospitals. Assessment for appropriateness of first aid done in four categories as follow, Fluid management 69.62% (1,146 cases), Respiratory care 65.49% (241 cases), Wound care and stop bleeding 51.64% (741 cases), Retention of fracture 46.14% (633 cases). This result revealed that trauma care nursing of community hospitals in Surin province was under 90% standard criteria of Bureau of Epidemiology, Department of Disease Control. This research therefore develops the referral system to improve quality of trauma care to meet the standard criteria.
Objective: To improve the referral system of Surin Hospital
Study Design: Operations Research
Method: The research described into 3 phases, 1) Problems and requirement analysis phase; data was collected by trauma surveillance record designed by Bureau of Epidemiology, Department of Disease Control. Then characterized the problems and root cause analysis by fish bone diagram. 2) Problem solving phase; resolutions were made and prioritize by criteria weighting scale technique. This phase also include created trauma referral guideline of Surin province. 3) Resolutions testing phase by; 3.1 Compare the potential in first aid and trauma care by nursing record and referral assessment created by participation of in-charged nurses in department of emergency from community hospitals. After ward test for its reliability by Scott's equation (inter- rater reliability index = 0.96) 3.2 Study the impact on Surin province referral system by self-created questionnaire for nurses in department of emergency of community hospitals. Reliability calculated by Kuder Richardson method (= 0.71).
Result:
1) Most of Registered nurses in department of emergency from community hospital in Surin province have knowledge in first aid and trauma care as guided in Surin referral guidelines (more than 85%) and regularly followed the guideline for more than 80%.
2) Comparison of potential of first aid and trauma care; trauma patients referred from community hospitals to Surin hospital has higher level of first aid and trauma care by year as 78.2%, 84.0% and 91.7% respectively. The appropriateness of first aid and trauma care continually increase to 92.6% over the standard criteria (more than 90%). However when consider in each category, stop bleeding still lower than standard (88.4%),
Conclusion: The result of this research based on hypothesis that improvement of trauma patient referral system consequently resulted in better quality of trauma care. As the result; researchers suggest for quality improvement of referral trauma care plan which integrated for the entire province. We also require continually support in knowledge of nursing care, equipments and budged for sustainable quality.
Key words: Referral system, First aid, Trauma care