急诊科出院患者未完成专科门诊转诊：一项前瞻性队列研究。

Noncompletion of referrals to outpatient specialty clinics among patients discharged from the emergency department: a prospective cohort study.

机构信息

Department of Family and Community Medicine, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, Canada.

出版信息

CJEM. 2010 Jul;12(4):325-30. doi: 10.1017/s1481803500012410.

DOI:10.1017/s1481803500012410

PMID:20650025

Abstract

OBJECTIVE

We sought to characterize patients who are referred from the emergency department (ED) to specialty clinics but do not complete the referral, and to identify reasons for their failure to follow up.

METHODS

A prospective cohort study was carried out over 3 months of patients who were discharged from the ED of a teaching hospital with referral to internal medicine, cardiology or neurology clinics, but who did not complete the referral. Information on demographics, barriers to care and reasons for not completing the referral was obtained through a standardized telephone interview.

RESULTS

Of 171 ED referrals, 42 (24.6%) were not completed. Interviews were completed for 71.4% (30 patients). Of the nonattenders, 80% were functional in English and most had high school (73.1%) or university (60.7%) education. Virtually all (93.0%) interviewees could get to hospital by themselves or have someone take them. Only 42.9% (12 patients) understood why the emergency physician (EP) requested consultation, and 42.9% (12 patients) described EP instructions as poor or fair. Primary reasons for noncompletion of consult were patient choice (46.7%, 95% confidence interval [CI] 27.1%-66.2%), physical or social barriers (13.3%, 95% CI 0.0%-27.2%), communication failure (20%, 95% CI 4.0%-36.0%) and consultant's refusal of the consultation (20% [95% CI 4.0%-36.0%]). All consultant refusals were from one internal medicine clinic, representing 42% (8/19) of ED referrals to that clinic. None of the 6 patients interviewed who were declined consultation was aware that their consultation had been refused.

CONCLUSION

Patients discharged by the EP with referral to specialty clinics frequently do not complete the consultation. Causes for failure to follow up relate to patient decision, inadequate or poorly understood discharge information, and system factors. Institutional audits of patients who fail to complete follow-up may reveal unanticipated barriers to care.

摘要

目的

我们旨在描述从急诊科（ED）转介到专科诊所但未完成转介的患者，并确定他们未能随访的原因。

方法

对在教学医院的 ED 出院并转介到内科、心脏病或神经病诊所但未完成转介的患者进行了为期 3 个月的前瞻性队列研究。通过标准化电话访谈获取人口统计学、护理障碍和未完成转介的原因等信息。

结果

171 例 ED 转介中，有 42 例（24.6%）未完成。对 71.4%（30 例）的患者进行了访谈。未就诊者中，80%的人英语能力尚可，大多数人具有高中（73.1%）或大学（60.7%）学历。几乎所有（93.0%）的受访者都可以自行或有人陪同前往医院。只有 42.9%（12 例）的患者能理解为什么急诊医生（EP）要求会诊，42.9%（12 例）的患者认为 EP 的医嘱很差或一般。未完成会诊的主要原因是患者选择（46.7%，95%置信区间 [CI] 27.1%-66.2%）、身体或社会障碍（13.3%，95% CI 0.0%-27.2%）、沟通失败（20%，95% CI 4.0%-36.0%）和顾问拒绝会诊（20%[95% CI 4.0%-36.0%]）。所有顾问拒绝都是来自一个内科诊所，占 ED 转介到该诊所的 42%（8/19）。没有一位接受访谈并被拒绝会诊的 6 名患者知道他们的会诊被拒绝了。