Walls Theresa A, Chamberlain James M, Strohm-Farber Jessica, Klein Bruce L
Children's National Medical Center, Washington, DC 20010, USA.
Pediatr Emerg Care. 2010 Aug;26(8):567-70. doi: 10.1097/PEC.0b013e3181ea71f8.
Before effective educational interventions can be implemented to improve health care, a needs assessment is essential to determine areas best targeted for improvement. The purpose of this study was to assess the educational needs of referring community hospitals with regard to the pretransport care of pediatric patients.
We performed a prospective survey of physicians accepting referrals from community hospitals in the emergency department of a large, urban, academic, pediatric hospital. Based on the routine pretransport telephone consultation, we asked the accepting physician to document the appropriateness of the referring hospital's management of the patient before the request for transport. We reviewed the corresponding transport records of all children for whom pretransport care was categorized as suboptimal. We report frequencies and relative frequencies for suboptimal care, reasons for suboptimal care, and the pretransport diagnoses of these patients.
There were 817 pediatric patients transported from 54 different hospitals during the 3-month study period, for which we received 477 surveys (58% response rate). The accepting physician rated the pretransport care as suboptimal for 105 (22%) of 477 patients. The most common diagnoses of referrals were respiratory distress, asthma, and seizures. Care was more likely to be reported suboptimal for patients with fever (P = 0.001) and asthma (P = 0.04).
Using a simple survey, we identified opportunities for improvement in the management of pediatric emergency patients by referring hospitals in 22% of cases.
在实施有效的教育干预措施以改善医疗保健之前，进行需求评估对于确定最适合改进的领域至关重要。本研究的目的是评估转诊社区医院在儿科患者转运前护理方面的教育需求。
我们对一家大型城市学术儿科医院急诊科接收社区医院转诊的医生进行了一项前瞻性调查。基于常规的转运前电话咨询，我们要求接收医生记录转诊医院在请求转运前对患者管理的适当性。我们审查了所有转运前护理被归类为次优的儿童的相应转运记录。我们报告了次优护理的频率和相对频率、次优护理的原因以及这些患者的转运前诊断。
在为期3个月的研究期间，有817名儿科患者从54家不同的医院转运而来，我们收到了477份调查问卷（回复率为58%）。接收医生将477名患者中的105名（22%）的转运前护理评为次优。转诊的最常见诊断是呼吸窘迫、哮喘和癫痫发作。对于发热（P = 0.001）和哮喘（P = 0.04）患者，护理更有可能被报告为次优。
通过一项简单的调查，我们发现转诊医院在22%的病例中存在改善儿科急诊患者管理的机会。
