Development of a comprehensive referral and follow-up model for critically ill emergency patients at Phanomphrai Hospital.

Abstract

      This study was an action research based on the conceptual framework of Kemmis & McTaggart, aiming to assess the situational problems, develop a comprehensive referral and follow-up model for critically ill emergency patients, and evaluate the effectiveness of the developed model. The study was conducted from October 2024 to October 2025, covering a period of one year. The sample consisted of 42 healthcare personnel involved in the referral process and 268 critically ill emergency patients (ESI 1-2) who were transferred during the study period. Research instruments included a critical patient data recording form, the Barthel Index assessment, and a satisfaction questionnaire, all of which were validated for content validity (IOC ≥ 0.80) and reliability (Cronbach's Alpha ≥ 0.85). Data were analyzed using descriptive statistics and the Paired t-test.

      The findings revealed that the developed model, the 4C Model (Community Critical Care Chain), comprised four main components: C1: Critical Triage & Stabilize, C2: Connected Transfer, C3: Coordinated Refer Back, and C4: Community Follow-up. The model was developed through two participatory action research cycles involving multidisciplinary teams. After implementing the model, the Door-In-Door-Out (DIDO) time decreased from 78 ± 14 minutes to 55 ± 8 minutes. The rate of adverse events during transfer declined from 15.2% to 10.0%, and the mortality rate during transfer decreased from 3.8% to 1.4%. Community follow-up rates increased from 52.8% to 92.0%, and the proportion of patients with Barthel Index ≥ 60 at 30 days increased from 55.0% to 79.0%. Caregiver satisfaction scores improved from 3.2 ± 0.7 to 4.5 ± 0.4, while personnel satisfaction scores increased from 3.4 ± 0.6 to 4.6 ± 0.3. All primary indicators showed statistically significant differences (p < 0.05).