Banerjee S, Beatty S, Tyagi A, Kirkby G R
Birmingham and Midland Eye Centre, UK.
Eye (Lond). 1998;12 ( Pt 5):880-2. doi: 10.1038/eye.1998.222.
To evaluate the appropriateness of triage decisions in a busy ophthalmic casualty department and to assess the diagnostic and management skills of eye-dedicated nurse practitioners.
Three hundred and one consecutive patients attending the Birmingham and Midland Eye Centre (BMEC) accident and emergency (A&E) department over a 2 week period were included in this prospective study. Patients were categorised in terms of urgency in concordance with strict guidelines, and the agreement between the final diagnosis and this system of prioritisation was then investigated. To evaluate nurse practitioner (NP) skills, all patients seen and managed by a NP were also assessed by the most senior doctor in casualty at the time in a masked fashion. Waiting times and a breakdown of waiting times were also calculated.
Upon establishment of a diagnosis, triage category allocation was found to be appropriate in all 301 cases. Fifty patients (16.67%) were seen by the NP. Of these the supervising doctor concurred with the NP diagnosis in all cases and with the proposed management in 96% of cases. The mean waiting time (+/- SD) was 83.43 +/- 45.84 min, with a range of 5-335 min. The delay before being attended to was greater for less urgent cases as categorised by the triage system.
This study confirms the high standard of diagnostic and management skills of the ophthalmic NP and indicates that the triage system of patient prioritisation is accurate. Waiting times in the A&E department remain unacceptable and ways of addressing this include improved ophthalmic training of general practitioners, diverting a greater proportion of non-acute cases to the primary care clinic and expanding the role of the NP.
评估繁忙眼科急症科分诊决策的合理性，并评估眼科专科护士从业者的诊断和管理技能。
这项前瞻性研究纳入了在两周内连续就诊于伯明翰和米德兰兹眼科中心（BMEC）急诊部的301例患者。根据严格指南对患者的紧急程度进行分类，然后研究最终诊断与该优先排序系统之间的一致性。为评估护士从业者（NP）的技能，当时急诊部最资深的医生还以盲法对所有由NP诊治的患者进行了评估。还计算了等待时间及其细分情况。
确诊后，发现301例患者的分诊类别分配均恰当。50例患者（16.67%）由NP诊治。其中，上级医生在所有病例中均认可NP的诊断，在96%的病例中认可所提议的治疗方案。平均等待时间（±标准差）为83.43±45.84分钟，范围为5 - 335分钟。分诊系统分类为不太紧急的病例，其接受诊治前的延迟时间更长。
本研究证实了眼科NP的诊断和管理技能处于高标准，并表明患者优先排序的分诊系统准确无误。急诊部的等待时间仍然无法接受，解决此问题的方法包括改善全科医生的眼科培训、将更大比例的非急症病例分流至初级保健诊所以及扩大NP的职责。
