Jones C S, McGowan A
Department of Accident and Emergency Medicine, Pinderfields General Hospital, Wakefield.
BMJ. 1989 Apr 1;298(6677):859-62. doi: 10.1136/bmj.298.6677.859.
To determine whether patients referring themselves to an accident and emergency department for another opinion after consulting their general practitioner present with serious illness, show any risk factors for being admitted, or are more likely to be patients of particular practitioners.
Six month prospective survey.
District general hospital's accident and emergency department, receiving 42,000 new patients a year.
180 Patients identified as attending for another opinion having already consulted a general practitioner.
Classified as admission, referral to specialist clinic, follow up in accident and emergency department, or referral back to general practitioner.
Admission, with an analysis of admitted patients.
General outcome, diagnostic category, age, time of attendance, time since seen by general practitioner, and name of general practitioner were recorded. Forty seven patients were admitted, 99 were discharged back to the general practitioner (62 without a letter), and two died. Patients were most likely to be admitted if they attended within 24 hours after seeing a general practitioner, were aged under 5, or presented with respiratory or gastrointestinal complaints. Some general practitioners were overrepresented.
Important disorders present in this way, and therefore these patients should be seen by a doctor. Information about these attendances could be useful to general practitioners in reviewing their performance.
确定那些在咨询过全科医生后自行前往急诊科寻求其他意见的患者是否患有严重疾病、是否存在任何入院风险因素，或者是否更有可能是特定医生的患者。
为期6个月的前瞻性调查。
地区综合医院的急诊科，每年接待42000名新患者。
180名已咨询过全科医生并前往寻求其他意见的患者。
分为入院、转至专科门诊、在急诊科随访或转回全科医生处。
入院情况，并对入院患者进行分析。
记录总体结果、诊断类别、年龄、就诊时间、自上次看全科医生以来的时间以及全科医生的姓名。47名患者入院，99名患者转回全科医生处（62名无转诊信），2名患者死亡。如果患者在看全科医生后24小时内就诊、年龄在5岁以下或出现呼吸道或胃肠道症状，则最有可能入院。一些全科医生的患者比例过高。
以这种方式就诊的患者存在重要疾病，因此应由医生进行诊治。这些就诊信息可能有助于全科医生评估自己的工作表现。
