Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA.
J Trauma Acute Care Surg. 2013 Jun;74(6):1541-7. doi: 10.1097/TA.0b013e31828c3f75.
Treatment at Level I/II trauma centers improves outcomes for patients with severe injuries. Little is known about the role of physicians' clinical judgment in triage at outlying hospitals. We assessed the association between physician caseload, case mix, and the triage of trauma patients presenting to nontrauma centers.
A retrospective cohort analysis of patients evaluated between January 1, 2007, and December 31, 2010, by emergency physicians working in eight community hospitals in western Pennsylvania. We linked billing records to hospital charts, summarized physicians' caseloads, and calculated rates of undertriage (proportion of patients with moderate-to-severe injuries not transferred to a trauma center), and overtriage (proportion of patients transferred with a minor injury). We measured the correlation between physician characteristics, caseload, and rates of triage.
Of 50 eligible physicians, 29 (58%) participated in the study. Physicians had a mean (SD) of 16.8 (10.1) years of postresidency clinical experience; 21 (72%) were board certified in emergency medicine. They evaluated a median of 2,423 patients per year, of whom 148 (6%) were trauma patients and 3 (0.1%) had moderate-to-severe injuries. The median undertriage rate was 80%; the median overtriage rate was 91%. Physicians' caseload of patients with moderate-to-severe injuries was inversely associated with rates of undertriage (correlation coefficient, -0.42; p = 0.03). Compared with physicians in the lowest quartile, those in the highest quartile undertriaged 31% fewer patients.
Emergency physicians working in nontrauma centers rarely encounter patients with moderate-to-severe injuries. Caseload was strongly associated with compliance with American College of Surgeons' Committee on Trauma guidelines.
Therapeutic/care management, level IV.
在一级/二级创伤中心治疗可改善严重创伤患者的预后。对于边远医院医生临床判断在分诊中的作用知之甚少。我们评估了医生工作量、病例组合与非创伤中心创伤患者分诊之间的关系。
这是对 2007 年 1 月 1 日至 2010 年 12 月 31 日期间在宾夕法尼亚州西部 8 家社区医院工作的急诊医生评估的患者进行的回顾性队列分析。我们将计费记录与医院病历相关联，总结了医生的工作量，并计算了分诊不足（中度至重度损伤患者未转至创伤中心的比例）和分诊过度（轻度损伤患者转至创伤中心的比例）的发生率。我们测量了医生特征、工作量与分诊率之间的相关性。
在 50 名符合条件的医生中，有 29 名（58%）参与了研究。医生的平均（SD）住院后临床经验为 16.8（10.1）年；21 名（72%）为急诊医学委员会认证医师。他们每年评估中位数为 2423 名患者，其中 148 名（6%）为创伤患者，3 名（0.1%）为中度至重度损伤。分诊不足率中位数为 80%；分诊过度率中位数为 91%。医生中度至重度损伤患者的工作量与分诊不足率呈负相关（相关系数，-0.42；p=0.03）。与处于最低四分位数的医生相比，处于最高四分位数的医生分诊不足的患者少 31%。
在非创伤中心工作的急诊医生很少遇到中度至重度损伤的患者。工作量与美国外科医师学会创伤委员会指南的遵守情况密切相关。
治疗/护理管理，IV 级。
