Warren B H, Bell P L, Isikoff S, Hale P L
Department of Internal Medicine, University of Arizona College of Medicine, Tucson.
Arch Intern Med. 1991 Apr;151(4):741-4.
A review of emergency department visits during a 2-year period and before and after the liberation of physicians from a requirement of gatekeeping for some patients during the night showed no significant increases in the use or costs of services to our Medicaid enrollees for all but children under 6 years of age between 10 PM and midnight. We recommend that a more humane and practical view be taken of middle-of-the-night gatekeeping requirements for physicians functioning in managed-care environments. We also suggest, as many hospitals have already learned, that the costs of emergency department services for Medicaid patients can be reduced and that care may be enhanced by the offering of 24-hour urgent care services at or near the emergency department.
对两年期间以及医生在夜间不再需要对部分患者进行守门之后的急诊就诊情况进行回顾发现，除了晚上10点至午夜之间6岁以下儿童外，我们医疗补助计划参保者的服务使用量或成本没有显著增加。我们建议，对于在管理式医疗环境中工作的医生的午夜守门要求应采取更人性化和实际的观点。我们还建议，正如许多医院已经认识到的，通过在急诊科或其附近提供24小时紧急护理服务，可以降低医疗补助患者的急诊科服务成本，并可能改善护理。
