Lee Rene S, Woods Rob, Bullard Michael, Holroyd Brian R, Rowe Brian H
Department of Emergency Medicine, University of Alberta, 1G1.43 WMC, 8440-112 Street, Edmonton AB, Canada.
Emerg Med J. 2008 Jan;25(1):4-9. doi: 10.1136/emj.2007.051631.
Consultation is a common and important aspect of emergency department (ED) practice which can lead to delays in patient flow. Little is known about ED consultations and this review systematically evaluated the literature on ED consultations.
Comprehensive searches of MEDLINE, PUBMED, SCIRUS, Cochrane Library, Web of Science, Health Star and other databases from 1966 to 2007 were performed. The grey literature and reference lists were searched and authors were contacted to identify other eligible studies. Published and unpublished studies reporting the proportion of consultations in the ED using any type of design were considered for this review. Eligible studies were required to involve patients presenting to the ED. Studies reporting on the proportion of consultation in a specific subpopulation of patients and interventions to improve consultations were also considered for inclusion. Two reviewers independently selected studies and extracted data from included studies regarding the proportion of consultations in the ED or the patient subgroup. Individual study proportions were calculated together with 95% confidence intervals (CI).
From more than 15,000 pre-screened citations, 12 studies were finally included in the review. All but three of the included studies were published. Overall, four studies examined ED consultation proportions, six identified the rate of consultation for special populations of ED presentations and two examined interventions to improve consultations. Consultation varied from 20% to 40% for all patients, with lower proportions in the selected populations studied and a high rate of hospitalisation for consulted patients. Limited research on interventions to improve the ED consultation process has also been completed.
Consultation research in the emergency setting is limited and variable; however, high consultation rates exist in some centres. This systematic review outlines the current state of the literature and suggests that further research is urgently needed.
会诊是急诊科诊疗工作中常见且重要的环节，但可能导致患者就诊流程延迟。目前对急诊科会诊了解甚少，本综述系统评价了有关急诊科会诊的文献。
对1966年至2007年期间的MEDLINE、PUBMED、SCIRUS、Cochrane图书馆、科学引文索引、健康之星及其他数据库进行全面检索。同时检索灰色文献及参考文献列表，并与作者联系以确定其他符合条件的研究。本综述纳入了采用任何设计报告急诊科会诊比例的已发表和未发表研究。符合条件的研究要求纳入在急诊科就诊的患者。报告特定患者亚组会诊比例及改善会诊干预措施的研究也在纳入考虑范围内。两名评审员独立筛选研究，并从纳入研究中提取有关急诊科或患者亚组会诊比例的数据。计算每项研究的比例及95%置信区间（CI）。
从超过15,000篇预筛选的文献中，最终12项研究被纳入本综述。纳入研究中除3项外均已发表。总体而言，4项研究考察了急诊科会诊比例，6项确定了特定急诊科就诊人群的会诊率，2项研究了改善会诊的干预措施。所有患者的会诊比例在20%至40%之间，在所研究的特定人群中比例较低，会诊患者的住院率较高。关于改善急诊科会诊流程干预措施的研究也很有限。
急诊科会诊研究有限且结果不一；然而，部分中心的会诊率较高。本系统综述概述了当前文献的现状，并表明迫切需要进一步研究。
