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

• Published in: International journal for quality in health care Vol. 34; no. 1
• Main Authors: Solà-Muñoz, Silvia, Azeli, Youcef, Trenado, Josep, Jiménez, Xavier, Bisbal, Roger, López, Àngels, Morales, Jorge, García, Xaime, Sánchez, Bernat, Fernández, José, Soto, Maria Ángeles, Ferreres, Yolanda, Cantero, Cristina, Jacob, Javier
• Format: Journal Article
• Language: English
• Published: UK Oxford University Press 28-03-2022
• Subjects: Aged; COVID-19 - epidemiology; Female; Hospitals; Humans; Male; Middle Aged; Original; Time Management; COVID-19; dispatch centre; emergency care; critical illness; triage management
• ISSN: 1353-4505; 1464-3677
• DOI: 10.1093/intqhc/mzac011

Abstract
Background
The overburdening of the healthcare system during the coronavirus disease 19 (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.
Objective
The aim of this study was to analyse the usefulness of the application of a prioritization score (IHTCOVID-19) for inter-hospital transfer of patients with COVID-19 infection.
Methods
The study has a quasi-experimental design and was conducted on the Medical Emergency System, the pre-hospital emergency department of the public company belonging to the Autonomous Government of Catalonia that manages urgent healthcare in the region. Patients with a 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 IHTCOVID-19 score was from 1 to 30 April 2020 (from 8 am to 8 pm). The prioritization score comprises four priority categories, with Priority 0 being the highest and Priority 3 being the lowest. Inter-hospital transfer (IHT) management times (alert-assignment time, resource management time and total central management time) and their variability were evaluated according to whether or not the IHTCOVID-19 score was applied.
Results
A total of 344 IHTs 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 IHTCOVID-19 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 IHTCOVID-19 score, there was a significant reduction in total central management time [from 112.4 (inter-quartile range (IQR) 281.3) to 89.8 min (IQR 154.9); P = 0.012]. This significant reduction was observed in Priority 0 patients [286.2 (IQR 218.5) to 42.0 min (IQR 58); P = 0.018] and Priority 1 patients [130.3 (IQR 297.3) to 75.4 min (IQR 91.1); P = 0.034]. After applying the IHTCOVID-19 score, the average time of the process decreased by 22.6 min, and variability was reduced from 618.1 to 324.0 min.
Conclusion
The application of the IHTCOVID-19 score in patients with a severe COVID-19 infection reduces IHT management times and variability.