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Of 14,821 patients who had major heart attacks and were sent to these hospitals from other facilities, only 1,627 patients, or 11 percent, were in and out of the referring facility in 30 minutes or less, according to the researchers.
Other limitations include: the possibility of incomplete transport or referring facility records not evident on chart review, i.e., if blood glucoses were checked on a glucometer but not documented by the referring facility.
Distance of the referring facility from our facility was not a risk factor for non-adherent to the guidelines.
Patients who were first seen at a referring facility and then seen at our emergency department before being admitted to the PICU were also excluded.
In these situations, ECMO cannulation at the referring facility and transfer by a transport ECMO team is a potentially lifesaving intervention.
This has been demonstrated previously by Barrios [15] and Clark [16] by a survey of providers caring for patients with DKA, but has not previously been demonstrated by reviewing all patient records of referring facility.
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Women who came directly to KCMC, bypassing referring facilities, were categorized as self-referred birthing women.
Records from referring facilities, transport team records, and PICU admission notes were reviewed.
Since non-adherence to guidelines was found statewide, it was clear that additional education was required in all referring facilities.
Because referring facilities treat a higher percentage of adults than children, it may be speculated that this is the reason that IV insulin and sodium bicarbonate was administered to pediatric patients referred to the PICU.
Prior studies have evaluated variability of care via surveys administered to physicians and providers at referring facilities [15, 16], but there has been little exploration into actual adherence of referring providers to pediatric DKA guidelines.
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