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Review of patients with multiple injuries treated at University Hospital, Kuala Lumpur

Silva JF

J Trauma, 1984 Jun;24(6):526-31.
PMID: 6737530

This study has analyzed 260 patients with multiple injuries sustained in road accidents admitted to the University Hospital during the period July 1967 to July 1976, in relation to age, sex, and ethnic distribution. The types of injuries sustained have been discussed to highlight their effects on the community in a developing country. The extremities have been most frequently involved, while head injuries followed closely. The causative factors of multiple injury-producing accidents have been evaluated. The categories of victims most liable to multiple injuries have been discussed. The significance of understanding the mechanism of these accidents and the effect of such knowledge in minimizing diagnostic errors, thus enabling management and the urgent need for regional accident services in developing countries, have been stressed.

Matched MeSH terms: Triage
Fulltext Patient attendance at a major accident and emergency department: are public emergency services being abused?

Azhar AA, Ismail MS, Ham FL

Med J Malaysia, 2000 Jun;55(2):164-8.
PMID: 19839143

A total of 37,152 patients attended the Accident & Emergency (A&E) Department of Hospital Universiti Kebangsaan Malaysia (HUKM) from 1st January to 31st December 1998. Attendance during early hours (midnight to 0659 hrs.) constituted only 10.4% (3853 cases) whereas that for three other time periods of 0700-1159 hrs., 1200-1759 hrs., and 1800-2359 hrs. was 29.4% (10,927 cases), 30.8% (11,448 cases), and 29.4% (10,924 cases) respectively. Two hundred and fifty-one patients were direct admissions from other hospitals into our hospital wards and they attended the A&E department for registration purposes only. Of the remaining 36,901 that were triaged, 196 (0.5%) were resuscitation cases [Triage 1], 3648 (9.9%) were emergency cases [Triage 21, 18,935 (51.3%) were urgent cases [Triage 3], and 14,122 (38.3%) were non-urgent cases [Triage 4]. Despite fluctuations in monthly patient attendance, the proportions of patients according to time of attendance, age group, gender and triage categories remained similar throughout. As majority of patients attended during convenient hours (89.6% from 0700-2359 hrs.) and a high proportion of patients (38.3%) belonged to the non-urgent Triage category, we feel that public emergency services are possibly being abused.

Matched MeSH terms: Triage
Fulltext Effective triaging in Putrajaya health clinic

Mohd Said N, Othman J, Hairi F

Malaysian Journal of Public Health Medicine, 2002;2(2):58-62.
MyJurnal

Malaysia's healthcare delivery system in Vision 2020 will be recognized as one of the world’s best. Putrajaya Health Clinic is our first paperless health clinic in Malaysia that incorporates the Health Information System (HIS). This system cuts across programmes and sections in the operational work process in the clinic with the ultimate aim of achieving a paperless status. This clinic provides a comprehensive health care service at the point of contact and focuses on wellness, clientfriendly, seamless and borderless care with e]§‘icient use of resources and towards high a quality of service. This health clinic which seesthe majority of the attendance being well persons, through the immunization programme, antenatal, postnatal, family planning, school health, and well clinics for child and adult, will continue to extend and further expand its services to include geriatric, ill mental, occupational and rehabilitative care. The e-government within Putrajaya will facilitate the use of an
appointment system, which can be done through e—mail, fax, telephone or walk-in. Information and
communication technology will also facilitate the promotion of health education for individuals and communities. To facilitate efective streaming or screening of clients/attendees, a simple triage system is introduced. Prompt, short and accurate is the rule for triaging, thus providing timely and ejfective care. New information and communication technologies will allow healthcare providers to adopt a more virtual, more integrated and more distributed approach in the delivery of health services. It was documented that the average contact time at the triage counter in Putrajaya Health Clinic was 1.16 minutes, i.e. the shortest among other services provided here.

Matched MeSH terms: Triage
Trauma care and limited resources

McConnell KJ

Ann Emerg Med, 2007 Jan;49(1):62-3.
PMID: 17084940
Matched MeSH terms: Triage
The use of an In House Scoring System Scale versus Glasgow Coma Scale in non-traumatic altered states of consciousness patients: can it be used for triaging patients in Southeast Asian developing countries?

Maheswaran M, Adnan WA, Ahmad R, Ab Rahman NH, Naing NN, Abdullah J

Southeast Asian J. Trop. Med. Public Health, 2007 Nov;38(6):1126-40.
PMID: 18613557

Non-traumatic Altered States of Consciousness (ASC) are a non-specific consequence of various etiologies, and are normally monitored by Glasgow Coma Scale (GCS). The GCS gives varriable results among untrained emergency medicine personel in developing countries where English is not the first language. An In House Scoring System (IHSS) scale was made by the first author for the purpose of triaging so as to quickly asses patients when seen by medical personel. This IHSS scale was compared to the GCS to determine it's specificity and sensitivity in the accident and emergency department (ED) of Hospital University Sains Malaysia (HUSM). All patients with non-traumatic ASC were selected by purposive sampling according to pre-determined criteria. Patients were evaluated by the two systems, IHSS and GCS, by emergency physicians who were on call. Patient demographics, clinical features, investigations, treatment given and outcomes were collected and followed for a period of 14 days. A total of 221 patients with non-traumatic ASC were studied, 54.3% were males. The mean age of the patients was 56 years old. The mean overall GCS score on presentation to the ED was 10.3. The mean duration of ASC was 11.6 hours. One hundred thirty patients (58.8%) experienced ASC secondary to general or focal cerebral disorders. The mortality rate was 40.3% 2 weeks after the ED visit. Fifty-four point three percent of the patients were awake and considered to have good outcomes while 45.7% of the patients had poor outcomes (comatose or dead) 2 weeks after the ED visit. The mean overall GCS score, verbal and motor subscores as well as the IHSS had significantly decreased (worsened) after treatment in the ED. A poor IHSS scale, hypertension, current smoking, abnormal pupillary reflexes and acidosis were associated with a worse 2-week outcome. The mean age and WBC count was lower and the mean overall GCS score and eye, verbal and motor subscores were higher as well as those having a lower IHSS scale for the good outcome category. Multivariate analysis revealed that smokers and hypertensives were at higher risk for a poor outcome. Higher eye scores on the GCS were associated fewer poor outcomes. There was significant agreement between the IHSS scale and GCS scores in the assessment of non-traumatic ASC. The sensitivity and specificity of the IHSS score versus GCS were 71.9% and 100.0%, respectively.

Matched MeSH terms: Triage/methods*
Fulltext A Study of Patients’ Satisfaction with the Emergency Department (ED) of Hospital Universiti Kebangsaan Malaysia (HUKM)

Isamil Saiboon, Ho, Siew Eng, Krishnan, Bala, Siti Norraini Ali, Noorafindi Murad, Pathnathan, Audrey, et al.

Medicine & Health, 2008;3(1):7-13.
MyJurnal

Patients’ satisfaction is of critical interest to all healthcare providers. Satisfied patients are more likely to seek health care and to comply with prescribed treatment regimes. The objective of the study was to identify factors that influence patient satisfaction with Emergency Department HUKM (ED HUKM). This study was conducted at ED HUKM from January 2007 till March 2007. A convenience sample of 100 participants was recruited from triage 4. The Davis Consumer Emergency Care Satisfaction Scale (CECSS) was adopted and modified. It consists of 19 questions; used a 5 point, Likert type scale of 1 to 5 (1= completely disagree and 5= completely agree) to measure patient satisfaction with triage, health care providers caring behaviours and health teaching. Results showed that 75 participants (75%) were satisfied. There were no significant difference found between male and female patients with total CESCC scores (t=0.308, p values >0.05). Pearson product moment correlation coefficients showed a positive relationship between total and subscale patient satisfaction scores, caring scores (r=0.905, p value

Matched MeSH terms: Triage
Fulltext Demographic and clinical characteristics of red tag patients and their one-week mortality rate from the emergency department of the Hospital Universiti Sains Malaysia

Ahmad R, Rahmat R, Hisamudin N, Rahman NA, Noh AY, Mohammad N, et al.

Southeast Asian J. Trop. Med. Public Health, 2009 Nov;40(6):1322-30.
PMID: 20578468

Early identification and rapid treatment of red tag patients may decrease morbidity and mortality. We examined the clinical characteristics, etiologies and one week mortality rate of red tag (life threatening and potentially life threatening illness) patients at the Hospital Universiti Sains Malaysai (HUSM). A cross-sectional study was conducted at the Emergency Department of the HUSM from 1 August 2006 to 31 January 2007; 440 eligible patients were analyzed. The group had a mean age of 47.2 +/- 22 years, with 67.3% of the patients being male. Twenty-three percent were trauma cases with motor vehicle accident being the major mechanism of injury. Fifty-four percent of the cases had cardiac related illnesses. The mean duration of stay in the Emergency Department (ED) was 3.9 +/- 1.5 hours. The survival rate at one week was 76.6%. The non-trauma group comprised 74.0% of death cases. Acute coronary syndrome and road traffic accidents comprised 22.0% of total death cases at one week. Red tag patients constitute a large proportion of ED cases and may remain in the ED for significant periods of time.

Study site: Hospital Universiti Sains Malaysia (HUSM)

Matched MeSH terms: Triage/methods*
Moving beyond the casemix frontier: towards sub-acute and non-acute classification. Abstracts of the 6th International Casemix Conference 2012 (6ICMC2012). Kuala Lumpur, Malaysia. June 6-7, 2012

BMC Health Serv Res, 2012 Nov 21;12 Suppl 1:I1-8, O1-10, P1-12.
PMID: 23210451
Matched MeSH terms: Triage
Fulltext Plasma level as marker for early detection of heart failure in primary hypertensive patients

Norsham J, Azmani SM, Roslan H, Latiff MA

Malaysian Journal of Medicine and Health Sciences, 2012;8(1):13-19.
MyJurnal

Heart failure is chiefly the end stage of primary hypertension and a major public health problem in Malaysia. The aim of this work is to investigate the level of BNP that may discriminate between primary hypertension patients without heart failure and primary hypertensive patients with heart failure. This study was conducted on 60 hypertensive patients without any clinical symptoms of heart failure referred for echocardiography to evaluate the ventricular function. Patients with metabolic diseases and terminal diseases were excluded from the study. The BNP levels were assessed using the Triage Meter from Biosite Diagnostics. Results showed that BNP level display a negative correlation with ejection fraction (Pearson correlation test). The significant result (paired t test, p < 0.05) proves that both predictors are very important and relates to each other. Low ejection fraction is significantly marked with raised BNP level suggesting that BNP may play potential role as screening tool for early detection of heart failure in primary hypertensive patients.

Study site: (Universiti Kebangsaan
Malaysia Medical Center and International Medical University cardiology clinic, Seremban

Matched MeSH terms: Triage
Fulltext Failure to improve door-to-needle time by switching to emergency physician-initiated thrombolysis for ST elevation myocardial infarction

Loch A, Lwin T, Zakaria IM, Abidin IZ, Wan Ahmad WA, Hautmann O

Postgrad Med J, 2013 Jun;89(1052):335-9.
PMID: 23524989 DOI: 10.1136/postgradmedj-2012-131174

INTRODUCTION: Achieving target door-needle times for ST elevation myocardial infarction remains challenging. Data on emergency department (ED) doctor-led thrombolysis in developing countries and factors causing delay are limited.
OBJECTIVES: To assess the effect on door-needle times by transferring responsibility for thrombolysis to the ED doctors and to identify predictors of prolonged door-needle times.
METHODOLOGY: Data on medical on-call team-led thrombolysis at a tertiary Asian hospital were prospectively collected from May 2007 to Aug 2008 (1st study period). In September 2008, ED doctors were empowered to perform thrombolysis. The practice change was accompanied by new guidelines, tick chart implementation, and training sessions. Data were then consecutively collected from September 2008 to May 2009 (2nd study period). Door-to-needle times for the 1st and 2nd study periods were compared. All cases were analysed for factors of delay by multiple logistic regression.
RESULTS: 297 patients were thrombolysed, 169 by the medical on-call team during the 1st study period and 128 by the ED doctors during the 2nd study period. Median door-needle times were 54 and 48 min, respectively (p=0.76). Significant delays were predicted by 'incorrect initial ECG interpretation' (adjusted OR (aOR) 14.3), 'inappropriate triage' (aOR 10.4) and 'multiple referrals' (aOR 5.9). No cases of inappropriate thrombolysis were recorded.
CONCLUSIONS: Transfer of responsibility for thrombolysis to the ED doctors did not improve door-needle times despite measures introduced to facilitate this change. Key causative factors for this failure were identified.
KEYWORDS: Accident & Emergency Medicine; Quality improvement
Study site: Emergency department, University Malaya Medical Centre, Kuala Lumpur

Matched MeSH terms: Triage/standards*
Fulltext Management of Emergency Department Overcrowding (EDOC) in a teaching hospital

Nik Azlan, N.M., Ismail, M.S.

Medicine & Health, 2013;8(1):0-0.
MyJurnal

Emergency Department Overcrowding (EDOC) has been a longstanding problem. It is defined as a situation where the demand for emergency services exceeds the ability of an Emergency Department (ED) to provide quality care within appropriate time frames. Hospital beds closure or access block to ward admission is one of the most important cause of Emergency s e.g. disaster. A surge response entails even greater responses including implementing Department overcrowding. This could be compounded further in events of a patient surge eg affirmative measurement in order to mitigate the issue in tackling the situation. The steps in managing EDOC were: 1. Recognizing EDOC, 2. Initiating action, 3. Maintaining patient flow, 4. Setting clinical goals and 5. Deploying a Surge Team for Advance Triage or Fast Tract.

Matched MeSH terms: Triage
Multi-sources data fusion framework for remote triage prioritization in telehealth

Salman OH, Rasid MF, Saripan MI, Subramaniam SK

J Med Syst, 2014 Sep;38(9):103.
PMID: 25047520 DOI: 10.1007/s10916-014-0103-4

The healthcare industry is streamlining processes to offer more timely and effective services to all patients. Computerized software algorithm and smart devices can streamline the relation between users and doctors by providing more services inside the healthcare telemonitoring systems. This paper proposes a multi-sources framework to support advanced healthcare applications. The proposed framework named Multi Sources Healthcare Architecture (MSHA) considers multi-sources: sensors (ECG, SpO2 and Blood Pressure) and text-based inputs from wireless and pervasive devices of Wireless Body Area Network. The proposed framework is used to improve the healthcare scalability efficiency by enhancing the remote triaging and remote prioritization processes for the patients. The proposed framework is also used to provide intelligent services over telemonitoring healthcare services systems by using data fusion method and prioritization technique. As telemonitoring system consists of three tiers (Sensors/ sources, Base station and Server), the simulation of the MSHA algorithm in the base station is demonstrated in this paper. The achievement of a high level of accuracy in the prioritization and triaging patients remotely, is set to be our main goal. Meanwhile, the role of multi sources data fusion in the telemonitoring healthcare services systems has been demonstrated. In addition to that, we discuss how the proposed framework can be applied in a healthcare telemonitoring scenario. Simulation results, for different symptoms relate to different emergency levels of heart chronic diseases, demonstrate the superiority of our algorithm compared with conventional algorithms in terms of classify and prioritize the patients remotely.

Matched MeSH terms: Triage/organization & administration*
Secondary triage classification using an ensemble random forest technique

Azeez D, Gan KB, Mohd Ali MA, Ismail MS

Technol Health Care, 2015;23(4):419-28.
PMID: 25791174 DOI: 10.3233/THC-150907

BACKGROUND: Triage of patients in the emergency department is a complex task based on several uncertainties and ambiguous information. Triage must be implemented within two to five minutes to avoid potential fatality and increased waiting time.
OBJECTIVE: An intelligent triage system has been proposed for use in a triage environment to reduce human error.
METHODS: This system was developed based on the objective primary triage scale (OPTS) that is currently used in the Universiti Kebangsaan Malaysia Medical Center. Both primary and secondary triage models are required to develop this system. The primary triage model has been reported previously; this work focused on secondary triage modelling using an ensemble random forest technique. The randomized resampling method was proposed to balance the data unbalance prior to model development.
RESULTS: The results showed that the 300% resampling gave a low out-of-bag error of 0.02 compared to 0.37 without pre-processing. This model has a sensitivity and specificity of 0.98 and 0.89, respectively, for the unseen data.
CONCLUSION: With this combination, the random forest reduces the variance, and the randomized resembling reduces the bias, leading to the reduced out-of-bag error.
KEYWORDS: Decision support system; emergency department; random forest; randomized resampling

Matched MeSH terms: Triage
Fulltext Effectiveness of ultrasound as a triage tool in ruling out fractures among non-critical emergency department patients

Nik Muhamad, N.A., anesan Murthi, J., Nik Ismail, N.A.

Medicine & Health, 2015;10(2):103-111.
MyJurnal

The popularity of ultrasound for acute diagnosis of fractures in the Emergency Department (ED) has increased over the recent years. This present study aimed to determine the sensitivity and specificity of ultrasound use for detection of fractures in a different environment, which is at the triage area of the ED. We compared the results of bedside ultrasound in detecting non-critical fractures to the current gold standard of X-rays in the triage area. The design was a single centered crosssectional study. From August 2014 till November 2014, a total of 46 patients were recruited, creating 75 image pairs. Following consent, a bedside ultrasound was performed and subsequently compared with X-ray reporting regarding the presence or absence of fractures. SPSS analysis was used to determine the sensitivity and specificity of ultrasound in diagnosing fracture as compared to X-rays. Ultrasound had a sensitivity of 72% (95% CI, 50.6% - 87.9%) and a specificity of 80% (95%CI: 66.3 - 90%) when compared to X-rays in fracture diagnosis. The kappa analyses showed moderate inter observer agreement (0.5) between ultrasound and X-rays in diagnosing fractures. This study suggests that the use of ultrasound as a triage tool yet has unacceptable sensitivity and needs further evaluation and consideration.

Matched MeSH terms: Triage
How to improve CVD risk prediction in a low-risk population [abstract]

Chia YC

J Hypertens, 2016 Sep;34 Suppl 1 - ISH 2016 Abstract Book:e16-e17.
PMID: 27753834

Conference abstract SY04-4: Many cardiovascular disease (CVD) risk prediction tools have been developed in an attempt to identify those at highest risk in order for them to benefit from interventional treatment. The first CVD risk tool that was developed was the coronary heart disease risk tool by the Framingham Heart Study in 1998 (1). However the Framingham Risk Score could overestimate (or underestimate) risk in populations other than the US population. Hence several other risk engines have also been developed, primarily for a better fit in the communities in which the tools are to be used (2, 3). Having said that the Framingham Heart Study risk tool has been validated in several populations (4, 5) and found to work reasonably well after some recalibration.Most risk prediction tools predict short term risk ie over a period of 10 years but since more recently risk tools now attempt to predict life-time risk or at least risk over the next 30 years. (6-8). The practical use of these risk prediction tools is that it is able to separate those at high risk (ie > 20% risk of a CVD event fatal or non-fatal event in the next 10 years) from those with the lowest risk (< 10% risk over 10 years). It then helps practitioners to triage them to either receive preventive therapy (high risk group) or none at all (low risk group) respectively. However in those with medium risk ie between 10-20%, the decision to offer treatment or not is less clear. In such a situation, other CVD risk factors for example family history of premature coronary heart disease, other biomarkers like elevated hs-CRP, presence of chronic kidney disease or albuminuria can be employed to further stratify risk.It is known that risk prediction tools are very much age dependent and in a younger individual with mildly raised CVD risk factors, his global CVD risk may be grossly under-estimated. Here additional CVD risk factors beyond those traditionally used in risk engines should be sought in order to recalibrate that individual's seemingly low risk and earlier intervention introduced if indeed he is of higher risk than what has been predicted by the conventional risk tools. Here too the use of life-time risk is probably of more importance than the traditional 10 year risk tool, again in order to identify those seemingly at "low" risk 10 year risk to receive treatment if the life-time risk is greater compared to an individual of the same age with optimal parameters. Furthermore while it is known that those with highest risk benefit the most from intervention, it is the population at large with the low or lower risk which contributes most to total CV morbidity and mortality in a country or community.Hence while short term risk prediction to identify those at highest risk is useful particularly in the presence of limited resources, attention should also be paid to those with short term low risk if the aim is to reduce CVD morbidity and mortality in any substantial way.

Matched MeSH terms: Triage
Fulltext The Assessment, Evaluation, and Management of the Critically Ill Child When Resources are Limited-Southeast Asian Perspective

Tang SF, Lum L

J Pediatr Intensive Care, 2017 Mar;6(1):6-11.
PMID: 31073420 DOI: 10.1055/s-0036-1584672

The Southeast Asia region comprises 10 independent countries with highly divergent health systems and health status. The heterogeneity in infant and child mortality rates suggests that there is still scope for improvement in the care of critically ill children. There is, however, a paucity of published data on outcomes and processes of care that could affect planning and implementation of intervention programs. Significant challenges in the delivery of care for the critically ill child remain, especially in pre-hospital and in-hospital triaging and emergency care and inpatient hospital care. Potential areas for continued improvement include strengthening of health systems through sustained commitment by local governments, capacity building, and sharing of research output. Simple, low cost, locally available, and effective solutions should be sought. The introduction of standards and auditing tools can assist in determining effectiveness and outcomes of intervention packages that are adapted to local settings. Recognition and acknowledgment of shortfalls between expectations and outcomes is a first step to overcoming some of these obstacles necessary to achieve a seamless interface among pre-hospital, emergency, inpatient, and critical care delivery processes that would improve survival of critically ill children in this region.

Matched MeSH terms: Triage
Fulltext Cross-cultural adaptation of modified dental pain screening questionnaire (M-DePaQ) in a primary dental care clinic in Kuala Lumpur

Kia ACL, Dalia Abdullah, Seong JS, Chiang SC, Pau A

Malaysian Journal of Public Health Medicine, 2017;17(1):38-45.

A validated screening tool for patient triage based on the pain symptoms, could potentially optimize the resources and expertise available in dental pain management. The aim of this study was to translate and validate the Modified Dental Pain Questionnaire (M-DePaQ) for use in categorizing patients with pain into three groups of common dental conditions. Forward Malay and Chinese translation was performed, followed by backward English translation. The translation was reviewed by an expert panel and pre-tested on patients who are native speakers.Consecutive patients aged 18 years and older experiencing pain and attending the primary dental care clinic completed the questionnaires. Four calibrated dentists made clinical diagnoses independent of the questionnaire responses. For data analysis, the cases were split randomly into Random Sample 1 (RS1) and Random Sample 2 (RS2). Discriminant analysis was performed on RS1 to develop a model for classifying dental pain cases into three groups. The model was applied to cases in RS2, and a cross-validated accuracy rate was obtained. Criterion validity was assessed using measures such as sensitivity, specificity, positive predictive value, and kappa. Of the 234 questionnaires distributed, 216 (92.3%) were returned. Classification rates were recorded at 73.8% for RS1, 75.0% for RS2, and 71.1% for all cases. The sensitivity values were 0.72, 0.39, and 0.43 for Groups 1, 2, and 3, respectively. The corresponding specificity values were 0.42, 0.87, and 0.94. The discriminant validity of the adapted questionnaire was satisfactory, but the criterion validity could not be established because of biases incorporated in the study.

Matched MeSH terms: Triage
Systematic Review of Real-time Remote Health Monitoring System in Triage and Priority-Based Sensor Technology: Taxonomy, Open Challenges, Motivation and Recommendations

Albahri OS, Albahri AS, Mohammed KI, Zaidan AA, Zaidan BB, Hashim M, et al.

J Med Syst, 2018 Mar 22;42(5):80.
PMID: 29564649 DOI: 10.1007/s10916-018-0943-4

The new and ground-breaking real-time remote monitoring in triage and priority-based sensor technology used in telemedicine have significantly bounded and dispersed communication components. To examine these technologies and provide researchers with a clear vision of this area, we must first be aware of the utilised approaches and existing limitations in this line of research. To this end, an extensive search was conducted to find articles dealing with (a) telemedicine, (b) triage, (c) priority and (d) sensor; (e) comprehensively review related applications and establish the coherent taxonomy of these articles. ScienceDirect, IEEE Xplore and Web of Science databases were checked for articles on triage and priority-based sensor technology in telemedicine. The retrieved articles were filtered according to the type of telemedicine technology explored. A total of 150 articles were selected and classified into two categories. The first category includes reviews and surveys of triage and priority-based sensor technology in telemedicine. The second category includes articles on the three-tiered architecture of telemedicine. Tier 1 represents the users. Sensors acquire the vital signs of the users and send them to Tier 2, which is the personal gateway that uses local area network protocols or wireless body area network. Medical data are sent from Tier 2 to Tier 3, which is the healthcare provider in medical institutes. Then, the motivation for using triage and priority-based sensor technology in telemedicine, the issues related to the obstruction of its application and the development and utilisation of telemedicine are examined on the basis of the findings presented in the literature.

Matched MeSH terms: Triage/methods*
Real-Time Remote Health-Monitoring Systems in a Medical Centre: A Review of the Provision of Healthcare Services-Based Body Sensor Information, Open Challenges and Methodological Aspects

Albahri OS, Zaidan AA, Zaidan BB, Hashim M, Albahri AS, Alsalem MA

J Med Syst, 2018 Jul 25;42(9):164.
PMID: 30043085 DOI: 10.1007/s10916-018-1006-6

Promoting patient care is a priority for all healthcare providers with the overall purpose of realising a high degree of patient satisfaction. A medical centre server is a remote computer that enables hospitals and physicians to analyse data in real time and offer appropriate services to patients. The server can also manage, organise and support professionals in telemedicine. Therefore, a remote medical centre server plays a crucial role in sustainably delivering quality healthcare services in telemedicine. This article presents a comprehensive review of the provision of healthcare services in telemedicine applications, especially in the medical centre server. Moreover, it highlights the open issues and challenges related to providing healthcare services in the medical centre server within telemedicine. Methodological aspects to control and manage the process of healthcare service provision and three distinct and successive phases are presented. The first phase presents the identification process to propose a decision matrix (DM) on the basis of a crossover of 'multi-healthcare services' and 'hospital list' within intelligent data and service management centre (Tier 4). The second phase discusses the development of a DM for hospital selection on the basis of integrated VIKOR-Analytic Hierarchy Process (AHP) methods. Finally, the last phase examines the validation process for the proposed framework.

Matched MeSH terms: Triage
The Global Spine Care Initiative: care pathway for people with spine-related concerns

Haldeman S, Johnson CD, Chou R, Nordin M, Côté P, Hurwitz EL, et al.

Eur Spine J, 2018 09;27(Suppl 6):901-914.
PMID: 30151811 DOI: 10.1007/s00586-018-5721-y

PURPOSE: The purpose of this report is to describe the development of an evidence-based care pathway that can be implemented globally.
METHODS: The Global Spine Care Initiative (GSCI) care pathway development team extracted interventions recommended for the management of spinal disorders from six GSCI articles that synthesized the available evidence from guidelines and relevant literature. Sixty-eight international and interprofessional clinicians and scientists with expertise in spine-related conditions were invited to participate. An iterative consensus process was used.
RESULTS: After three rounds of review, 46 experts from 16 countries reached consensus for the care pathway that includes five decision steps: awareness, initial triage, provider assessment, interventions (e.g., non-invasive treatment; invasive treatment; psychological and social intervention; prevention and public health; specialty care and interprofessional management), and outcomes. The care pathway can be used to guide the management of patients with any spine-related concern (e.g., back and neck pain, deformity, spinal injury, neurological conditions, pathology, spinal diseases). The pathway is simple and can be incorporated into educational tools, decision-making trees, and electronic medical records.
CONCLUSION: A care pathway for the management of individuals presenting with spine-related concerns includes evidence-based recommendations to guide health care providers in the management of common spinal disorders. The proposed pathway is person-centered and evidence-based. The acceptability and utility of this care pathway will need to be evaluated in various communities, especially in low- and middle-income countries, with different cultural background and resources. These slides can be retrieved under Electronic Supplementary Material.

Matched MeSH terms: Triage

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