Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, CT, USA.
Acad Emerg Med. 2010 Dec;17(12):1374-82. doi: 10.1111/j.1553-2712.2010.00927.x. Epub 2010 Nov 22.
problems with on-call specialist physician coverage have been identified as a significant issue for our nation's health care system. Despite this, little is known about the full extent of these coverage deficiencies in emergency departments (EDs), their effect on emergency care provision, or the subsequent effect on patient flow should specialist-requiring patients need to be transferred to centers of higher-level care. The objective was to report the experiences of a national sample of ED directors regarding the degree of difficulty in providing specialist coverage and the effect of on-call coverage problems on emergency patient care.
the authors conducted a cross-sectional self-administered survey of a national sample of ED directors. How frequently ED directors reported on-call coverage problems, whether they recently lost on-call coverage, whether their current on-call coverage was reliable, and the potential effect on emergency care provision were all assessed.
the overall response rate was 62% (442 of 715). Seventy-four percent of respondents reported on-call coverage problems with specialist physicians. Sixty percent reported having lost 24/7 coverage for at least one specialty in the past 4 years. Twenty-six percent reported unreliability in their current on-call coverage. Twenty-three percent noted that their trauma center designation level had been affected by on-call coverage, and 22% noted an increase in patients leaving before being seen by a medically needed specialist.
difficulties in obtaining specialty on-call coverage are a pervasive issue for EDs at the national level. Emergency care provision appears to have been affected, and this issue is further impacted by a perceived unreliability in current on-call coverage provision as well as the attrition of coverage for individual specialties.
已经确定，值班专科医生的覆盖范围存在问题，这是美国医疗保健系统的一个重大问题。尽管如此，对于急诊部（ED）中这些覆盖范围缺陷的全部程度、它们对紧急护理提供的影响，以及需要转移到更高层次护理中心的专科需求患者的后续患者流程影响，人们知之甚少。目的是报告全国范围内 ED 主任在提供专科覆盖范围方面的困难程度以及值班覆盖范围问题对急诊患者护理的影响方面的经验。
作者对全国范围内的 ED 主任进行了横断面自我管理调查。调查内容包括 ED 主任报告值班覆盖范围问题的频率、他们最近是否失去了值班覆盖范围、他们当前的值班覆盖范围是否可靠，以及对紧急护理提供的潜在影响。
总体回复率为 62%（715 名中的 442 名）。74%的受访者报告说，专科医生的值班覆盖范围存在问题。60%的受访者报告说，在过去 4 年中，至少有一个专业的 24/7 覆盖范围已经失去。26%的受访者报告说，他们当前的值班覆盖范围不可靠。23%的人指出，他们的创伤中心指定级别受到值班覆盖范围的影响，22%的人指出，需要专科医生治疗的患者在就诊前离开的人数有所增加。
在全国范围内，获得专科值班覆盖范围的困难是 ED 普遍存在的问题。紧急护理的提供似乎已经受到影响，而且由于当前值班覆盖范围的可靠性以及个别专科的覆盖范围的减少，这一问题进一步受到影响。
