HASTANE ÖNCESI ACIL SAĞLIK HIZMETLERI SUNUM SÜRECINDE YAŞANAN SORUNLAR

Abstract

Acil sağlık hizmetleri bütün dünyada olduğu gibi ülkemizde de sağlık hizmetlerinin en vazgeçilmez, en hızlı yapılması gereken hizmetleridir. Yapılan bir çok çalışmada kaza, akut hastalık veya kriz anlarında ilk beş dakika, ilk yarım saat ve ilk birkaç saat içinde müdahale hayat kurtarma veya sakat kalmama açısından çok önemlidir. Ülkemizde sağlık dönüşüm programı uygulaması çerçevesinde acil sağlık hizmetleri de yeniden yapılandırılmıştır. Bu yapılanma ile merkezde Sağlık Bakanlığı bünyesinde kurulmuş olan Acil Sağlık Hizmetleri Genel Müdürlüğü, illerde ise Sağlık Müdürlükleri bünyesinde acil sağlık hizmetleri yürütülmektedir. Yeni yapılanma acil sağlık hizmetlerinin alt yapısını güçlendirmekle beraber, etkinliğini, hızını artırmıştır. Bununla birlikte sistemin işlemesinde ve özellikle vakaya ulaşım, müdahale ve taşıma aşamalarında karşılaşılan sorunlar mevcuttur. Bu çalışma Trabzon ili özelinde mevcut sorunları tespit etmek ve yönetici ve uygulamacılara sorunların tespiti ve çözüm önerisi geliştirmede katkı yapmak üzere, yönetimin katılımıyla gerçekleştirilmiştir. Elde edilen bulgulara göre; 112 acil sağlık hizmetlerinin altyapı, vakaya hazırlık ve insan kaynakları imkanlarının ve örgütlenme yapısının sağlıkta dönüşüm programı dahilinde ciddi anlamda güçlendirildiği yapılan çalışmalardan anlaşılmaktadır. Bu nedenle bu konularda yüksek düzeyde sorun ifadesi fazla yoktur. Fakat dış faktörler bağlı olan vakaya ulaşım ve müdahale süreçlerinde ciddi sorunlar yaşanmaktadır. Bu durumun nedenleri başlıca iki başlıkta incelebilir. Birincisi; mevcut bina, yol ve diğer altyapı ve ekonomik imkanların toplumsal yapılanma ve gelişmeye getirdiği sınırlılıkların acil müdahale süreçlerine yansımasıdır ki, bu düşünceyi destekleyen, bina merdiven ve asansörlerinin, yolların yetersizliği sorunlarıdır. İkinci neden ise toplumsal eğitim, kültür ve mantalite sorunudur

Objectives: The present study was conducted to determine issues experienced during provision of emergency health services before hospitalization of patients and to suggest solution for hospital administrations and practitioners for eliminating relevant bottlenecks. Methods: Whereas the study covered 459 health service personnel at the emergency service in Trabzon City, Turkey in 2016, a Likert-type survey method was harnessed as a data collection tool whose reliability and validity were tested. Collected study data were analyzed for their frequency and significance test. Results: Based on the obtained findings, it was determined that emergency health services have been strengthened in terms of infrastructure, preparedness for cases and human resources and organizational structure. However, substantial issues were observed with the accessing and intervention process to cases reported considered as external factors. Conclusion: These issues could mainly be classified under two groups: the first is reflection of limitations introduced by the established buildings, roads and other infrastructure and the influence of economic opportunities on social organization and development on emergency service intervention processes; and this contributes into our case with inadequate structural features of buildings, stairs, elevators, roads, gates. The second is the issue related with social education, culture and mentality. Reflections of the second group issues could be observed in false and malicious calls made to emergency service, violation of right of way assigned to ambulances, adverse attitudes of relatives of patients and verbal attack aiming at emergency service personnel Likewise all over the world, emergency health services are the most inseparable element of health services, which requires race with time. Numerous studies have revealed that intervention made in the first five minutes, half-an-hour and in the first hour after experiencing an accident, acute disease or trauma is vitally important in terms of saving lives or preventing disability. Along the program of transition in health services applied in Turkey, emergency health services have been reorganized. This reorganization has both strengthened infrastructure of emergency health services and advanced its efficiency and agility. Nevertheless, there are various issues with the operation of the service and especially with having access, intervention to cases and in logistic phases of the process. The present study was conducted to determine the issues experienced during the provision of emergency health services in the pre-hospitalization period and to assist administrations and practitioners in terms of determining problems and making suggestions for resolution of these problems. Emergency health service given before hospitalization is a service branch which requires highly intensive and stressful work load (Duran et al., 2012: 144). Additionally, emergency health crews might face difficulties during intervention into the reported cases. It is commonly known that emergency crew members would encounter difficulties in having access to case locations while they are providing emergency health services in traffic environment because of other drivers’ ignorance of traffic rules or of traffic jam (Karakuş et al., 2014). 112 stations are required to be located in proximity of city center in order to intervene in cases immediately (Handerson & Mason, 2004). Another difficulty encountered in accessing cases especially with services provided to countryside is reported as improper width of roads in rural areas and poor traffic signage. Moreover, limited free space around the residential areas in urban areas makes access of ambulance units difficult; and living and passage areas in buildings non-conforming to the standards obstructs accessing patients (Uskun et al., 2007). Based on all of these characteristics and issues that could be encountered during performance of this duty, it is possible to conclude that provision of emergency health services has a quality which challenges human nature. Especially anxiety and other psychological problems could be observed with emergency health service personnel (Annagür, 2010). This finding suggests that emergency health service personnel might need psychological support. In the preliminary study, development phases of emergency health services in Turkey were introduced briefly; and issues laid by former studies were tried to be determined. In the present study, it was aimed to determine issues experienced at application level; to review the relevant literature and to make suggestions to administrations for resolution of revealed problems so as to make a contribution to the subject. Methods As the study was planned for March 2016; necessary initiatives were taken with the City Health Directorate and City Governorship for implementation of the survey study structured in five-point Likert style, a qualitative research method. Finally, the ultimate survey form was prepared under the title of “The Survey Form for Determining Issues Related with the Emergency Health Services in the Pre-Hospitalization Period” applied on voluntary basis to the emergency health personnel and their administrations on duty at the Branch Directorship, the Command and Control Center and 30 different ASHİ units in Trabzon City in the period of June and July 2016. Finally, 459 valid survey forms were collected. For reliability analysis of the scale, Cronbach's Alpha coefficient was estimated at 0.84 which suggests that the proposed survey could be considered as reliable. The KMO value was estimated at 0.881. Additionally, the Barlett sphericality test was employed for evaluation of significance of correlation among items; and significance was determined as 0.000 (Approx. Chi-Square: 4237.924/ df: 496/ sig: 0.000). In order to assess dimensions of items, “Direct Oblimin” rotation operation was executed by the “Principal Components” method. Results and Discussion The present study was conducted to determine issues encountered by emergency health services personnel in the pre-hospitalization period. In general, it was determined in this study that while level of issues expressed concerning the dimensions of infrastructure, case preparedness and human resources were at medium level, higher level of issues was reported with the dimension of case intervention. Especially, substantial issues were determined as false or malicious calls made to emergency call centers and difficulties experienced in confirmation of case addresses. As it was reported by Uskun et al. (2007) concerning the emergency services in the pre-hospitalization period, inappropriate features of stairs and elevators of buildings for handling of patients; and exposed traffic accident risks subject to roads, traffic jam and drivers as it was determined by Karakuş et al. (2014), Uskun et al. (2007) and Yılmaz (2012) were put in prominence. In parallel with findings reported by Yıldız (2015) and Budak (2015), adverse attitudes of relatives of patients, exposure to verbal assaults were among the dimensions which came to foreword. Moreover, reluctance of hospital emergency services to administer patients was considered as another major issue. Ineffective utilization from air ambulances and insufficient number of runways for air ambulances in urban areas was also emphasized. The personnel’s need for in-service training was brought to forefront as well. Conclusion and Suggestions Finally, it was realized that infrastructure, case preparedness and human resources and organizational structure of emergency health services were further strengthened along the health transformation program based on the present study. Accordingly, no significant issues were determined regarding these dimensions. Another issue was determined as psychological support need of personnel because of the stress, difficulty, verbal and physical assaults encountered in this profession. It would be important to recruit psychologists and social service specialists to fulfill psychological needs of employees regularly. Considering weight lifting capacity of applicant during recruitment process for especially ambulance crew would make positive contribution to resolution of issues that arise during patient handling processes. Need for in-service training should not be limited to vocational developments, self-improvement, ethical, patient rights and communication dimensions must be covered as well.