Development of Emergency Patient Referral Practice Guidelines for Critical Conditions in the Emergency Department at Bandanlanhoi Hospital, Sukhothai Province.

Abstract

ABSTRACT

            This action research study, based on Kemmis and McTaggart's framework, aimed to develop and evaluate practice guidelines for emergency patient referral with critical conditions in the Emergency Department at Bandanlanhoi Hospital, Sukhothai Province. The study involved 10 registered nurses and emergency medical personnel, along with 100 referred patients, conducted between August and November 2025. The research followed a four-phase action research cycle: Planning, Action, Observation, and Reflection, adhering to the National Institute for Emergency Medicine (NIEM) standards. Research instruments included questionnaires, knowledge assessment forms, practical skills evaluation forms, and satisfaction surveys. Data were analyzed using descriptive statistics and the Wilcoxon Signed-rank test.

            The findings revealed that the developed practice guidelines comprised six main components: (1) patient assessment and triage using standard criteria, (2) pre-referral preparation, (3) coordination through the REFER coordination center, (4) care during transfer, (5) patient handover using the SBAR technique, and (6) documentation and evaluation. Following implementation, healthcare personnel demonstrated significantly increased knowledge (median scores improved from 17.00 to 22.50, p<0.001) and practical skills (median scores increased from 101.00 to 140.00, p=0.002). Staff satisfaction with the practice guidelines was at the highest level (𝑥̅=4.57, SD=0.35), while patient satisfaction with emergency referral services was at a high level (𝑥̅=4.40, SD=0.42). The study recommends expanding these practice guidelines to other community hospitals and health service units in Health Region 2, along with developing long-term patient follow-up systems using digital technology to ensure effective and sustainable critical care management.