Emergency Department, Ninewells Hospital, Dundee, UK.
Emerg Med J. 2010 Mar;27(3):213-5. doi: 10.1136/emj.2008.064261.
This study aimed to compare the opinions of consultants in emergency medicine and general practitioners (GPs) on the appropriateness of NHS 24 referrals to the emergency department (ED).
170 NHS 24 referrals to the ED were reviewed by six GPs and six emergency consultants who were asked their opinion as to which out-of-hours service would be most appropriate for the patient. Modal responses from both groups were calculated for each referral. Consensus within groups and levels of agreement were calculated.
Modal responses agreed with an ED disposal in 59.2% of cases in the emergency consultant group with a 90% consensus rate. The GP group agreed with an ED disposal in only 47% of cases with a 75.9% consensus rate. A primary care referral response was the mode in 20.8% of the emergency consultant group compared with 35.7% in the GP group. Consensus was reached in 76.3% of the emergency consultant responses and 81.7% of GP responses. The difference in opinion between the two study groups was statistically significant.
GPs and consultants in emergency medicine both believe a high proportion of NHS 24 referrals to the ED should be handled by primary care services. This would suggest that, compared with previous out-of-hours practice, NHS 24 favours an ED outcome. The results indicate a large proportion of primary care patients are being handled inappropriately and uneconomically in the ED setting. There is a need for ongoing improvement of the telephone triage service provided by NHS 24.
本研究旨在比较急诊医学顾问和全科医生（GP）对 NHS 24 转至急诊部（ED）的适宜性的意见。
对 NHS 24 转至 ED 的 170 例患者进行了回顾，六位全科医生和六位急诊顾问被要求就哪种非工作时间服务最适合患者发表意见。计算了每组对每个转介的模式反应。计算了组内和组间的一致性。
在急诊顾问组中，有 59.2%的情况下，模式反应同意 ED 处置，共识率为 90%。GP 组仅在 47%的情况下同意 ED 处置，共识率为 75.9%。初级保健转介反应是急诊顾问组中的 20.8%，而 GP 组中的 35.7%。在急诊顾问的 76.3%和 GP 的 81.7%的反应中达成了共识。两组研究人员之间的意见差异具有统计学意义。
GP 和急诊医学顾问都认为 NHS 24 转至 ED 的很大一部分患者应该由初级保健服务处理。这表明与之前的非工作时间实践相比，NHS 24 更倾向于 ED 结果。结果表明，很大一部分初级保健患者在 ED 环境中处理不当且不经济。需要持续改进 NHS 24 提供的电话分诊服务。
