result of requesting C.C.U. Bed by hospital Emergency
ward from the Emergency Medical Services (EMS) in Shiraz
university of Medical Sciences in year 2003
S.Habibollah Kavari, PhD.
Address for correspondence
S.Habibollah Kavari, PhD.
Principal Lecturer of School of Management ,
and Medical Information Sciences
Shiraz University of Medical Sciences,
Inter Hospital transport is one of the most
important parts in Emergency Systems. Aim of this study is
to determine the result of requesting C.C.U bed from EMS in
the year 2003
Methods: In a sectional study, the records of 2688 patients
who go to Shiraz hospital Emergency wards and requesting C.C.U
beds from EMS were examined. These patients were divided into
2 groups: Those who are successful in getting the bed in other
hospitals and those who are not.
Findings: 68.5% of these cases were successful. There is a
close relationship between using logistic regression, recognition
hospital and being successful.
Conclusion: Increasing the C.C.U beds and providing the necessary
equipment in these wards are the most important factors that
should have priority in Shiraz.
Inter hospital transport is one of the most
important parts in Emergency systems in each country. So much
so that most of the developed countries in the world have
a practical definitive protocol for this matter. (1&2)
Unfortunately in Iran we do not have such a
system . The patient goes to hospital, for primary treatment
, and if the patient needs to be confined to bed, then other
events can occur, which may be harmful to the patient's health.
Emergency Medical Services of Shiraz University
of Medical Sciences has been established in Shiraz with the
help of remedy system management.
This department (section) coordinates the inter
hospital free beds. When the hospital declines a bed , this
section start to look for a free bed in other hospitals ,
governmental centers ,charity institutions and social and
private services. When its search is finished and it finds
a free bed, it notifies the relevant hospital to transport
the patient to this new locale . This provides a service to
the hospital, overcoming many difficulties as EMS cannot work
well without this service of finding C.C.U free beds.
For solving the possible problems and seeing
the effectiveness of the plan, they practice the drill. (3,
A sectional study has been done on those patients
who came to hospitals and needed to be confined to bed in
C.C.U wards which EMS found for them The Shiraz. Records of
2688 patients were reviewed and information gathered by looking
at the questionnaires that had been completed by Emergency
supervisors in EMS.
This information was reviewed and analyzed.
1510 patients (56.2%) were men , and all more than 2 years
of age. You can see the absolute and relative frequency distribution
of requested hospitals on the table 1.
Among these cases , 587 cases (21.8%) were transported
to other centers and confined to bed in spring , 658 cases
(25.5%) in summer ,791 cases(29.4%) in autumnl and 652 cases
(24.3%) in winter . With other definitions , patients were
confined to bed in the same hospital that they came to its
emergency ward , died , released or cancel their admissions
for any reason.
The relationship of sex, season, days of a week,
and place of patient's residence, work rotation, recognition
of C.H.F and MI, I.H.D in requested hospital with related
factors were reviewed and analyzed by using a logistic regression
The effect of independent factors that have
a significant statistical relation with related factors (1%
or less) were reviewed and analyzed too.
Table 1: Relative & absolute frequency
distribution of recorded cases according to requested hospital
|Ghalb al Zahra
1840 cases were successful and they were
accepted by other hospitals.
Table 2: Relative & absolute frequency
distribution of recorded cases according to the result of
|Accepted in other hospital
|Accepted in the same hospital
|Canceled the admission for any reason
Table 3: Relative & absolute frequency
distribution of successful acceptance according to different
|Percent of success
Days of a week
|Saturday to Wednesday
|Place of residence
|Evening & night
|CHF, pulmonary edema
2346 Cases (78.3%) were accepted
for MI and I.H.D. and 342 cases (12.7%) were accepted for
pulmonary edema and cardiac arrest.
The average time from the beginning to the end was 229 minutes.
Minimum time was 1 minute and maximum time was 8040 minutes
and average was 120 minutes. (SD=360)
The number of hospitals that
were called for acceptance were at least 5.8, at most 40 and
the average was 3(SD=6.6)
The relation of different factors with the rate (degree) of
success was shown in table 3. By looking at this table you
will see a significant relationship between season, work rotation,
recognition, type of requested hospital and success in acceptance.
By using a logistic regression we gain a multi variable equation
that you can see its result on table 4.
Table 4: gained outcomes
in accordance with logistic regression model
|Variable in the model
|Recognition of MI, IHD
|Ghalb-e- al Zahra
In this table you can see
that season, shift and recognition factors have a close relation
with success and this relation can be seen in Hafez &
Comparison of seasons shows
that the probability of acceptance is not the same in different
seasons. Spring, Summer and fall
have more acceptance than Winter. These probabilities are
3% in Spring, 5.1% in Summer and 1.2 % in fall.
Comparison of work rotation
shows that acceptance is more in morning and noon shifts.
Evening and night shifts has fewer acceptances. Rate of increase
in acceptance in morning /noon shifts are sequentially: 1.4
&1.5 times more than evening and night shifts.
The probability of I.H.D
and MI acceptance is 2.1 times more than pulmonary edemas
and cardiac arrest among mentioned hospitals just Hafez and
Zeinabiyeh hospitals have less probability to accept such
Inter hospital transport
is one of the most important aspects in Medical Emergency
Services in each country.
Emergency center, in international
standards, is a place that get acceptance for all the patients
who come to hospitals with prehospital emergency helps and
those patients who transport from one hospital to another
Most countries have the
immediate and necessary information about free beds in all
hospitals and they can, in critical events, transport the
patient that its bed is gotten before. (1)
As you see in the result
of this research, we still have problems with the rate of
C.C.U bed acceptance. Although so many activities have been
done for establishing C.C.U wards in Tehran and other cities,
the rate of acceptance is 68.5 % and in about 31.5% of other
patients we still have problem.
It seems that the main
problem in C.C.U wards is human power, equipment, physical
situation and budget. (Money). And as you know the last mentioned
factor (budget) is very important.
There is no justification
for significant relation between success in rate of C.C.U
acceptance and seasons.
Maybe because our hospitals
are training hospitals or because of epidemiological factors,
our C.C.U beds are more occupied in Summer than other seasons.
More studying should be
done to find a logic relationship between season and rate
At last based on findings we have some
- increase the number of C.C.U beds in Shiraz
- Develop the facilities in those hospitals
that have C.C.U beds.
- Centralized the emergency acceptance in Shiraz
emergency center with emergency automation. So that the
patient will not keep in emergency wards for long time.
- Increase the Emergency personnel and equipments.
|| Maryland institute for Emergency
Medical service system inter hospital transfer guidelines
manual, USA, 3rd edition, 2000
||Bayast A, Placo M. Dynamic
of bed use in accommodations Emergency admissions, BmJ,1999,
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ministry for health, remedy and medical education, standard
guide directions of emergency wards.
Iran-e-farda, year 1379
||Remedy & Drug assistants.
ministry f health , remedy and medical education , guide
direction drafts of establishment and management of emergency
wards in training hospitals in the country , edition year
||Dr. Gholamreza Ajorloo. "
collection of health, remedy and educational laws and
regulations ", fist edition, NASHR-E- JAHAN , year
||State organization for remedial
services, enforceable guide directions of Tehran emergency
centers, approved in board of ministers session dated