Ramrakha S, Giles A
Royal Prince Alfred Hospital, Camperdown, New South Wales.
Aust Fam Physician. 2001 Apr;30(4):395-8.
The overall aim of the study was to examine the quality of communication and the amount of patient information conveyed by general practitioners when referring patients to an emergency department. The study also looked at the prior use of telephone calls made by the referring doctors and ambulance usage for patients referred with a provisional diagnosis of acute coronary or cerebral event.
An audit of the first 998 patients who presented to the Liverpool Hospital emergency department with a referral letter, after initially presenting to their GP, was carried out between June and September 1997. Subgroup analysis was done on referral letters from the patients' own GP compared with another GP. The use of the telephone before sending the patient was also noted. The admitting officer entered patient information on a computerised 'expects screen'. On arrival, the mode of transport was ascertained, in particular, whether an ambulance was used in transporting these patients.
Of 998 consecutive patients with letters, the majority were not referred by the patient's own GP. The number of prior telephone calls to the admitting officer was low. If a patient was sent by their usual GP, a more detailed account of the patient's past medical history, investigations and management was given. In patients with a presumptive diagnosis of 'unstable angina pectoris' or 'acute myocardial infarction', 26% were transferred via ambulance. Only 12.5% were transported by ambulance with a presumptive diagnosis of a cerebral event, 'seizure', 'stroke' or 'CVA'.
For those patients who did present with a referral letter, the standard of information lacked consistency and there was a difference between the content of letter written by their usual GP as opposed to another GP. This study found there was infrequent telephone communication when patients were referred by their GP to the emergency department. This study also shows an under-utilisation of the ambulance service by GPs in south west Sydney when referring patients with coronary ischaemia or a cerebral event to the emergency department.
本研究的总体目标是检查全科医生将患者转诊至急诊科时的沟通质量以及传达的患者信息量。该研究还调查了转诊医生此前使用电话的情况，以及对初步诊断为急性冠状动脉或脑部事件的转诊患者使用救护车的情况。
1997年6月至9月间，对最初就诊于全科医生后持转诊信前往利物浦医院急诊科的前998例患者进行了审核。对患者自己的全科医生开具的转诊信与其他全科医生开具的转诊信进行了亚组分析。还记录了在送患者之前使用电话的情况。接诊人员在电脑化的“预期屏幕”上录入患者信息。患者到达时，确定其交通方式，特别是这些患者是否使用救护车运送。
在998例连续持信患者中，大多数不是由患者自己的全科医生转诊的。此前致电接诊人员的次数较少。如果患者由其常规全科医生转诊，会提供更详细的患者既往病史、检查和治疗情况。初步诊断为“不稳定型心绞痛”或“急性心肌梗死”的患者中，26%通过救护车转运。初步诊断为脑部事件、“癫痫发作”、“中风”或“脑血管意外”的患者中，只有12.5%通过救护车运送。
对于那些确实持转诊信前来就诊的患者，信息标准缺乏一致性，患者自己的全科医生开具的信与其他全科医生开具的信内容存在差异。本研究发现，全科医生将患者转诊至急诊科时，电话沟通很少。本研究还表明，悉尼西南部的全科医生在将冠心病缺血或脑部事件患者转诊至急诊科时，对救护车服务利用不足。
