急诊科信息缺口的患病率及其对患者结局的影响。
Prevalence of information gaps in the emergency department and the effect on patient outcomes.
作者信息
Stiell Andrew, Forster Alan J, Stiell Ian G, van Walraven Carl
机构信息
Clinical Epidemiology Unit, Ottawa Health Research Institute, ON.
出版信息
CMAJ. 2003 Nov 11;169(10):1023-8.
BACKGROUND
Information gaps occur when previously collected information is unavailable to a physician who is currently treating a patient. In this study we measured the prevalence of physician-reported information gaps for patients presenting to an emergency department at a teaching hospital.
METHODS
For 1002 visits to the emergency department made by 983 patients, we recorded all information gaps identified by the emergency physician immediately after the patient was assessed. When an information gap was present, the physician was asked to identify the required information, why it was required and how important it was to the patient's care. We reviewed the patient charts to measure severity of illness and to determine whether the patient was referred to the emergency department by a community physician. Multiple linear regression analysis was used to determine whether information gaps were associated with length of stay in the emergency department.
RESULTS
At least 1 information gap was identified in 323 (32.2%) of the 1002 visits (95% confidence interval 29.4%-35.2%). Information gaps were associated with severity of illness, being significantly more common in patients who had serious chronic illnesses, those who arrived by ambulance, those who had visited the emergency department or had been in hospital recently, patients in monitored areas in the emergency department and older patients. Information gaps most commonly comprised medical history (58%) and laboratory test results (23.3%) and were felt to be essential to patient care in 47.8% of the cases. The presence of information gaps was not associated with admission to hospital. After adjusting for important confounders, including patient sex, previous hospital admissions, diagnosis and severity of illness, we found that stays in the emergency department were 1.2 hours longer on average for patients with an information gap than for those without one.
INTERPRETATION
Information gaps were present in almost one-third of the visits to our emergency department. They were more common in sicker patients and were independently associated with a prolonged stay in the emergency department.
背景
当正在治疗患者的医生无法获取先前收集的信息时，就会出现信息缺口。在本研究中，我们测量了教学医院急诊科就诊患者中医生报告的信息缺口发生率。
方法
对于983名患者的1002次急诊科就诊，我们记录了急诊医生在对患者进行评估后立即识别出的所有信息缺口。当存在信息缺口时，要求医生确定所需信息、需要该信息的原因以及对患者护理的重要性。我们查阅患者病历以衡量疾病严重程度，并确定患者是否由社区医生转诊至急诊科。采用多元线性回归分析来确定信息缺口是否与急诊科住院时间相关。
结果
在1002次就诊中，有323次（32.2%）至少识别出1个信息缺口（95%置信区间29.4%-35.2%）。信息缺口与疾病严重程度相关，在患有严重慢性病的患者、乘坐救护车前来的患者、近期去过急诊科或住过院的患者、急诊科监测区域的患者以及老年患者中更为常见。信息缺口最常见的包括病史（58%）和实验室检查结果（23.3%），47.8%的病例认为这些信息对患者护理至关重要。信息缺口的存在与住院无关。在对包括患者性别、既往住院史、诊断和疾病严重程度等重要混杂因素进行调整后，我们发现有信息缺口的患者在急诊科的住院时间平均比没有信息缺口的患者长1.2小时。
解读
在我们急诊科近三分之一的就诊中存在信息缺口。它们在病情较重的患者中更为常见，并且与在急诊科的住院时间延长独立相关。
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