Emergency Department, Beaumont Hospital, Beaumont Road, Dublin, Ireland.
Emerg Med J. 2012 Jul;29(7):550-3. doi: 10.1136/emj.2010.109074. Epub 2011 Jun 14.
This study was undertaken to assess the usefulness of senior emergency medicine specialists' review of all 'did not wait' (DNW) patients' triage notes and the recall of at-risk patients. METHODS; A prospective study of all DNW patients was performed from 1 January to 31 December 2008. Following a daily review of charts of those who failed to wait to be seen, those patients considered to be at risk of adverse outcome were contacted by the liaison team and advised to return. Data were gathered on all DNW patients on the Oracle database and interrogated using the Diver solution.
2872 (6.3%) of 45,959 patients did not wait to be seen. 107 (3.7%) were recalled on the basis of senior emergency medicine doctor review of the patients' triage notes. Variables found to be associated with increased likelihood of being recalled included triage category (p<0.001), male sex (p<0.004) and certain clinical presentations. The presenting complaints associated with being recalled were chest pain (p<0.001) and alcohol/drug overdose (p=0.001). 9.4% of DNW patients required admission following recall.
The systematic senior doctor review of triage notes led to 3.7% of patients who failed to wait being recalled. 9.4% of those recalled required acute admission. The daily review of DNW patients' triage notes and the recalling of at-risk patients is a valuable addition to our risk management strategy.
本研究旨在评估资深急诊医学专家对所有“未等待”（DNW）患者分诊记录的审查以及对高危患者的召回的有用性。方法：对 2008 年 1 月 1 日至 12 月 31 日期间所有 DNW 患者进行了前瞻性研究。对那些未能等待就诊的患者的病历进行每日审查后，联络小组联系了那些被认为有不良后果风险的患者，并建议他们返回。从 Oracle 数据库中收集所有 DNW 患者的数据，并使用 Diver 解决方案进行查询。
在 45959 名患者中，有 2872 名（6.3%）未等待就诊。根据资深急诊医生对患者分诊记录的审查，有 107 名（3.7%）患者被召回。发现与更有可能被召回相关的变量包括分诊类别（p<0.001）、男性（p<0.004）和某些临床表现。与召回相关的主要症状包括胸痛（p<0.001）和酒精/药物过量（p=0.001）。召回后有 9.4%的 DNW 患者需要住院治疗。
对分诊记录进行系统的高级医生审查，导致 3.7%的未等待就诊的患者被召回。召回的患者中有 9.4%需要急性入院治疗。对 DNW 患者分诊记录的每日审查和对高危患者的召回是我们风险管理策略的有价值的补充。
