Patterson Victor, Humphreys Jenny, Henderson Mark, Crealey Grainne
Department of Neurology, Royal Victoria Hospital, Belfast, UK.
Qual Saf Health Care. 2010 Oct;19(5):e51. doi: 10.1136/qshc.2009.038513. Epub 2010 May 28.
Patients referred to secondary care in the UK often wait many months to be seen, and the UK government has announced various initiatives to address this issue. Since 2002, we have developed an email referral system which allows some neurological referrals to be managed by advice and investigations rather than by a conventional hospital clinic appointment. This system has previously been shown to reduce clinic attendances and to be acceptable to patients and their general practitioners (GPs).
To analyse the effects of an email triage system on waiting times, cost of care and safety over 5 years.
Referral numbers and waiting times for clinics using this system were analysed. Cost was determined by comparing detailed costs with those of conventional care. Safety was analysed by examining the GP records of all patients referred from a single practice who had been dealt with by advice or investigation, noting deaths, re-referrals and changes in diagnosis.
Waiting times fell from 72 to 4 weeks, despite an increase in referrals. The cost per patient of email referral was about £100, compared with £152 for conventional care, a 35% reduction. Safety data on 120 individuals showed a minor change in diagnosis in three.
This system is safe, effective (in reducing waiting times) and efficient. It enables neurologists to focus on patients with significant neurological disease and, if applied more widely, could reduce costs and waiting times for neurology services in the UK.
在英国，转诊至二级医疗保健机构的患者通常要等待数月才能就诊，英国政府已宣布多项举措来解决这一问题。自2002年以来，我们开发了一种电子邮件转诊系统，该系统允许通过建议和检查来管理一些神经科转诊，而不是通过传统的医院门诊预约。此前已证明该系统可减少门诊就诊次数，并且患者及其全科医生（GP）均可接受。
分析电子邮件分诊系统在5年时间里对等待时间、护理成本和安全性的影响。
分析使用该系统的诊所的转诊数量和等待时间。通过将详细成本与传统护理成本进行比较来确定成本。通过检查来自单一诊所的所有转诊患者的全科医生记录来分析安全性，这些患者已通过建议或检查进行了处理，记录死亡、再次转诊和诊断变化情况。
尽管转诊量有所增加，但等待时间从72周降至4周。电子邮件转诊的每位患者成本约为100英镑，而传统护理为152英镑，降低了35%。120人的安全数据显示，三人的诊断有轻微变化。
该系统安全、有效（在减少等待时间方面）且高效。它使神经科医生能够专注于患有严重神经疾病的患者，如果更广泛地应用，可降低英国神经科服务的成本和等待时间。
