During the medical rescue of Wenchuan earthquake, as a hospital which mainly admitted the severely wounded, West China Hospital immediately shifted to the double-track emergent system from the previous single-track system and dispatched sufficient manpower and materials. The beds in the Department of Orthopaedics were increased to 680. In addition, in order to ensure effective treatment, the hospital dealt with the wounded based on their specific conditions in different stages and optimized the flow of admission of the wounded. Besides, we opened the referral channel for the wounded. Up to June 2nd, 2008, a total of 2 618 wounded people have been treated in to the hospital, and 648 with minor injuries after proper treatment have been referred to the nearby basic-level hospitals.
To promote dual referral normalized management, West China Hospital of Sichuan University experimented in eight community health service centers under Wuhou District Health Bureau, depending on its advantages of regional medical coordination resources and the present advanced information technology. The experiment covered making appointments for referral, examination, consultation for intractable diseases and so on. The purpose was to explore appropriate mode and normalized management of dual referral between large comprehensive hospital and community health service centers, and promote normalization and systemization for dual referral.
Objective To explore the referral patterns for rehabilitation of patients with spinal cord injury (SCI) in community hospitals and establish green channel for SCI rehabilitation between community hospitals and large comprehensive hospitals. Methods Thirty SCI patients who were referred from the Center of Rehabilitation Medicine, West China Hospital to community hospitals between February 2013 and June 2014 were selected for this study. All the patients were assessed with American Spinal Injury Association (ASIA 2011), activities of daily living (ADL), and instrumental activities of daily living (IADL). Based on the assessment results, rehabilitation plan was made and the patients underwent community rehabilitation treatment. Results After rehabilitation treatment in community hospitals, the scores of ASIA, ADL and IADL in all the SCI patients were significantly higher than those at the time of referral (P<0.001). Conclusions SCI patients can accept rehabilitation treatment in community hospitals with good conditions. This practice can provide a new type of seamless referral pattern between large comprehensive hospitals and community hospitals for rehabilitation of SCI patients.
Objective To analyze the characteristics of patients transferred by ambulances to emergency department before and after coronavirus disease 2019 epidemic, in order to improve the efficiency of emergency triage, optimize the utilization of emergency resources, and provide a reference for standardized tiered medical services in different situation. Methods The patients’ information collected through Wenjuanxing questionnaire was extracted, who were transferred by ambulances to the Emergency Department of West China Hospital of Sichuan University between December 27th, 2018 and April 28th, 2019 (before epidemic), or between December 27th, 2019 and April 28th, 2020 (during epidemic), or between December 27th, 2020 and April 28th, 2021 [in regular epidemic prevention and control period (REPCP)]. The general information, sources, reasons for referral, disease spectrum and triage levels of patients in the three periods were compared. Results There were 3993, 2252 and 1851 cases before epidemic, during epidemic, and in REPCP, respectively. The differences in gender and age among the three periods were not statistically significant (P>0.05). The percentage of referrals from tertiary hospitals in each period was 74.00%, 72.65%, and 76.12%, respectively, which was higher in REPCP than that during epidemic (P<0.05). The percentage of direct referrals from emergency department in each period was 41.00%, 42.14%, and 44.46%, respectively, which was higher in REPCP than that before epidemic (P<0.05). The percentage of two-way referrals in each period was 37.79%, 36.63%, and 34.36%, respectively, which was lower in REPCP than that before epidemic (P<0.05). During epidemic and in REPCP, the proportions of referrals due to “need for surgery” (24.72%, 27.84%, and 28.74%, respectively) and “request by family members” (49.64%, 53.33%, and 56.24%, respectively) increased compared with those before epidemic (P<0.05), while the proportion of referrals due to “critical illness” decreased compared with that before epidemic (40.20%, 35.21%, and 33.17%, respectively; P<0.05); the proportion of referrals due to “diagnosis unknown” decreased in REPCP compared with that before epidemic (15.50%, 13.90%, and 11.89%, respectively; P<0.05). The proportion of acute aortic syndromes in REPCP increased compared with that during epidemic (3.46%, 2.98%, and 4.65%, respectively; P<0.05), the proportion of trauma in REPCP increased compared with that before epidemic (13.72%, 15.76%, and 17.77%, respectively; P<0.05), and the proportion of pneumonia/acute exacerbation of chronic obstructive pulmonary disease during epidemic and in REPCP decreased compared with that before epidemic (8.44%, 3.73%, and 3.84%, respectively; P<0.05). The proportion of critically ill patients referred in each period was 72.88%, 75.58%, and 79.15%, respectively, which was the highest in REPCP (P<0.05). Conclusions The epidemic has a significant impact on emergency ambulance referrals, and emergency triage needs to be continuously optimised and improved in staff, facilities, processes and management. It is necessary to further improve the implementation of hierarchical diagnosis and treatment, strengthen information communication between referral and emergency departments of receiving hospitals, and improve referral efficiency.
Neuroblastoma (NB) is the most common extracranial solid malignant tumor in children. NB has various clinical manifestations, many of which are not specific, which ultimately lead to the delayed diagnosis of the tumor. In order to provide guidance for the identification of paediatric NB, the guideline for the identification and referral of suspected paediatric neuroblastoma is formulated and complied using a standard formulation process, and has received input from multidisciplinary experts, based on existing evidence, clinical practices and China's national conditions.