Department of Internal Medicine, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer, University of Barcelona, 08036 Barcelona, Spain.
Am J Emerg Med. 2013 Jan;31(1):114-23. doi: 10.1016/j.ajem.2012.06.013. Epub 2012 Sep 11.
The aim of the present study was to determine whether quick diagnosis units (QDUs) can safely and efficiently avoid emergency department (ED) visits and hospitalizations.
We included a prospective cohort of 4170 consecutive patients and a retrospective cohort of 3030 hospitalized patients. Medical records of hospitalized patients were reviewed to determine whether patients were stable enough for outpatient diagnostic workup. We studied primary care (PC) and ED referral patterns in two 25-month periods. Hospital and QDU costs were analyzed by microcosting techniques, and a survey was evaluated using care preferences.
From December 2007 to December 2009, 66% QDU patients were referred from PC to ED and 25% from PC to QDU. From January 2010 to January 2012, 35% QDU patients were referred from PC to ED and 53% from PC to QDU (P < .0001). During the first period, 36% ED patients were referred to QDU and 65% (retrospective cohort) were hospitalized, compared with 64% and 35%, respectively, during the second period (P < .0001). Between 84% and 91% of hospitalized patients were stable for QDU workup, and their hospitalization might have been avoided. Cost per process was €3241.11 in hospitalized patients and €726.47 in QDU patients. Most patients preferred the QDU model and were reluctant to first being transferred to ED.
An increasing number of PC and ED patients were referred to the QDU. Hospitalizations might have been avoided in at least 84% of patients. Although QDU and hospitalization are similarly effective in reaching a diagnosis, the QDU model incurs fewer costs.
本研究旨在确定快速诊断单位（QDUs）是否能够安全有效地避免急诊就诊和住院。
我们纳入了一个连续的 4170 例患者的前瞻性队列和一个 3030 例住院患者的回顾性队列。回顾住院患者的病历，以确定患者是否足够稳定可以进行门诊诊断检查。我们在两个 25 个月的时间段内研究了初级保健（PC）和 ED 的转诊模式。通过微成本技术分析了医院和 QDU 的成本，并通过护理偏好评估了一项调查。
2007 年 12 月至 2009 年 12 月，66%的 QDU 患者从 PC 转诊至 ED，25%从 PC 转诊至 QDU。2010 年 1 月至 2012 年 1 月，35%的 QDU 患者从 PC 转诊至 ED，53%从 PC 转诊至 QDU（P<.0001）。在第一个时期，36%的 ED 患者被转诊至 QDU，65%（回顾性队列）住院，而在第二个时期，分别为 64%和 35%（P<.0001）。住院患者中 84%至 91%的患者稳定适合 QDU 检查，其住院治疗可能已被避免。住院患者的每个流程的费用为 3241.11 欧元，QDU 患者的费用为 726.47 欧元。大多数患者更喜欢 QDU 模式，不愿意先被转至 ED。
越来越多的 PC 和 ED 患者被转诊至 QDU。至少 84%的患者的住院治疗可能已被避免。虽然 QDU 和住院治疗在获得诊断方面同样有效，但 QDU 模式的成本较低。
