Trivedy Chetan R, Cooke Matthew W
Division of Health Sciences, Warwick Medical School, Coventry, UK Emergency Department, Heart of England NHS Foundation Trust, West Midlands, UK.
Emerg Med J. 2015 Apr;32(4):324-9. doi: 10.1136/emermed-2013-202719. Epub 2013 Oct 28.
Unscheduled return visits (URV) to the emergency department (ED) may be an important quality indicator of performance of individual clinicians as well as organisations and systems responsible for the delivery of emergency care. The aim of this study was to perform a rapid evidence assessment policy-based literature review of studies that have looked at URVs presenting to the ED. A rapid evidence assessment using SCOPUS and PUBMED was used to identify articles looking at unplanned returns to EDs in adults; those relating to specific complaints or frequent attenders were not included. After exclusions, we identified 26 articles. We found a reported URV rate of between 0.4% and 43.9% with wide variation in the time period defined for a URV, which ranged from 24 h to undefined. Thematic analysis identified four broad subtypes of URVs: related to patient factors, to the illness, to the system or organisation and to the clinician. This review informed the development of national clinical quality indicators for England. URV rates may serve as an important indicator of quality performance within the ED. However, review of the literature shows major inconsistencies in the way URVs are defined and measured. Furthermore, the review has highlighted that there are potentially at least four subcategories of URVs (patient related, illness related, system related and clinician related). Further work is in progress to develop standardised definitions and methodologies that will allow comparable research and allow URVs to be used reliably as a quality indicator for the ED.
急诊部门的非计划复诊（URV）可能是衡量个体临床医生以及负责提供急诊护理的组织和系统绩效的一项重要质量指标。本研究的目的是对已关注到的到急诊部门就诊的非计划复诊的研究进行基于政策的快速证据评估文献综述。使用SCOPUS和PUBMED进行快速证据评估，以识别研究成人非计划复诊至急诊部门的文章；不包括那些与特定主诉或频繁就诊者相关的文章。排除相关文章后，我们确定了26篇文章。我们发现报告的非计划复诊率在0.4%至43.9%之间，非计划复诊所定义的时间段差异很大，从24小时到未明确规定。主题分析确定了非计划复诊的四种主要亚型：与患者因素相关、与疾病相关、与系统或组织相关以及与临床医生相关。本综述为英格兰国家临床质量指标的制定提供了参考依据。非计划复诊率可能是急诊部门内质量绩效的一项重要指标。然而，文献综述表明，在非计划复诊的定义和测量方式上存在重大不一致。此外，该综述还强调，非计划复诊可能至少有四个子类别（与患者相关、与疾病相关、与系统相关和与临床医生相关）。目前正在开展进一步工作，以制定标准化的定义和方法，从而能够进行可比研究，并使非计划复诊能够可靠地用作急诊部门的质量指标。
