Department of Clinical Research, Lutheran Medical Center, Brooklyn, NY 11220, USA.
J Community Health. 2012 Feb;37(1):159-64. doi: 10.1007/s10900-011-9431-1.
Recent studies suggest that patients' elevated blood pressure (BP) readings in the Emergency Department (ED) may be due to hypertension (HTN) rather than pain and anxiety. Identifying BP patterns suggestive of HTN in the ED presents an opportunity for referral. The purpose of this prospective cohort study was to assess the feasibility of referral of ED patients with elevated BP readings suggestive of HTN. Adults with elevated BP suggestive of HTN and no history of HTN were tracked as to referral status using an actively monitored ED referral system. Patients referred to a community clinic network were tracked regarding clinic visits, subsequent BP, and diagnosis of HTN. Of 662 patients with elevated BP in the ED at triage, 197 (29.8%) had a pattern of blood pressure readings that were suggestive of HTN. Of these, 63 (32.0%) were referred to in-network clinics, 5 (2.5%) were referred out of network, and 129 (65.5%) were not referred. Of the 63 referred to network clinics, 17 (27.0%) kept their appointments and of those, 5 (29.4%) were diagnosed with HTN. Elevated BP was not mentioned in any ED physician referral notes as a reason for referral and the number of appointments kept among patients who were referred was low. Referral to outpatient clinics based on BP levels suggestive of HTN may not be feasible despite active referral systems.
最近的研究表明，患者在急诊部（ED）升高的血压（BP）读数可能是由于高血压（HTN）而不是疼痛和焦虑引起的。在 ED 中识别提示 HTN 的 BP 模式为转诊提供了机会。本前瞻性队列研究的目的是评估 ED 中升高的 BP 读数提示 HTN 的患者转诊的可行性。使用主动监测的 ED 转诊系统，对有升高的 BP 读数提示 HTN 且无 HTN 病史的成人进行转诊状态跟踪。转诊至社区诊所网络的患者就就诊情况、随后的 BP 和 HTN 诊断进行跟踪。在分诊时 ED 中有 662 例 BP 升高的患者，其中 197 例（29.8%）有提示 HTN 的血压读数模式。其中，63 例（32.0%）被转诊至网络内诊所，5 例（2.5%）被转诊至网络外，129 例（65.5%）未被转诊。在转诊至网络诊所的 63 例患者中，有 17 例（27.0%）预约了，其中 5 例（29.4%）被诊断为 HTN。ED 医生转诊记录中没有提到升高的 BP 作为转诊的原因，而且转诊患者的预约率也很低。尽管有主动转诊系统，但根据提示 HTN 的 BP 水平转诊至门诊诊所可能不可行。
