Biddle M L, Adler N R, Heath M, Streat S, Wardrop M, Watson J P
School of Medicine, Deakin University, Geelong, Victoria, Australia.
Intern Med J. 2014 Jun;44(6):581-5. doi: 10.1111/imj.12400.
Hepatology and gastroenterology services are increasingly utilising the skills and experience of nurse practitioners and nurse specialists to help meet the increasing demand for healthcare. A new nurse-led assessment clinic has been established in the liver clinic at Geelong Hospital to utilise the expertise of nurses to assess and triage new patients and streamline their pathway through the healthcare system.
The aim of this study is to assess quantitatively the first 2 years of operation of the nurse assessment clinic at Geelong Hospital, and to assess advantages and disadvantages of the nurse-led clinic.
Data were extracted retrospectively from clinical records of new patients at the liver clinic. Quarterly 1-month periods were recorded over 2 years. Patients were categorised according to the path through which they saw a physician, including missed and rescheduled appointments. The number of appointments, the waiting time from referral to appointments and the number of 'did-not-attend' occasions were analysed before and after the institution of the nurse-led assessment clinic. The Mann-Whitney rank sum test of ordinal data was used to generate median wait times.
There was shown to be a statistically significant longer waiting time for physician appointment if seen by the nurse first. The difference in waiting time was 10 days. However, there was also a reduction in the number of missed appointments at the subsequent physician clinic. Other advantages have also been identified, including effective triage of patients and organisation of appropriate investigations from the initial nurse assessment.
肝病学和胃肠病学服务越来越多地利用执业护士和专科护士的技能与经验，以满足日益增长的医疗保健需求。吉朗医院的肝病门诊开设了一个由护士主导的新评估诊所，以利用护士的专业知识来评估和分流新患者，并简化他们在医疗系统中的就医流程。
本研究旨在对吉朗医院护士评估诊所运营的头两年进行定量评估，并评估护士主导诊所的优缺点。
从肝病门诊新患者的临床记录中进行回顾性数据提取。记录了两年内每季度为期1个月的时间段。患者根据看医生的途径进行分类，包括错过和重新安排的预约。在设立护士主导的评估诊所之前和之后，分析了预约次数、从转诊到预约的等待时间以及“未就诊”情况的数量。使用有序数据的曼-惠特尼秩和检验来生成中位等待时间。
结果显示，如果先由护士看诊，患者等待医生预约的时间在统计学上显著更长。等待时间的差异为10天。然而，后续医生门诊的错过预约次数也有所减少。还发现了其他优点，包括对患者进行有效的分流以及从最初的护士评估开始组织适当的检查。
