Seong Augene, Osmun W E
Assistant Professor in the Division of Emergency Medicine at the University of Western Ontario in London.
Associate Professor in the Department of Family Medicine at the University of Western Ontario and a rural family physician and teacher at the Southwest Middlesex Health Centre and the Strathroy Middlesex General Hospital.
Can Fam Physician. 2014 Sep;60(9):e441-6.
To determine the effect of the presence of family medicine residents on the use of laboratory and imaging investigations in a rural emergency department (ED).
A retrospective cross-sectional electronic chart audit was completed. Background characteristics, as well as type and number of ordered investigations, were compared between study groups.
Strathroy Middlesex General Hospital in Strathroy, Ont, a rural community hospital that sees approximately 20 000 ED visits per year.
A total of 2000 sequential ED visits, including adult and pediatric patients. The test group consisted of patients seen while a resident was present in the ED. The control group consisted of patients seen while no residents were present in the ED.
Twenty-two distinct categories of common ED investigations were studied.
There was no statistically significant difference between study groups for 19 of the 22 categories of investigations. There were significant differences in 3 categories: an increased number of D-dimer assays for patients seen while there were no residents in the ED (1.7% of patients vs 0.5% of patients, P = .03) and increased computed tomography and ultrasound imaging for patients seen while a resident was in the ED (4.8% vs 1.8%, P = .0012, and 5.3% and 1.7%, P < .001, respectively). These differences are likely not owing to resident involvement but are explained by a difference in test availability between groups.
The study was underpowered for most categories of studied investigations. However, the trends demonstrated in this study suggest that the presence of family medicine residents in a rural community ED does not substantially affect the overall use of diagnostic investigations.
确定家庭医学住院医师的存在对农村急诊科实验室检查和影像检查使用情况的影响。
完成一项回顾性横断面电子病历审核。比较研究组之间的背景特征以及所开检查的类型和数量。
安大略省斯特拉斯罗伊的斯特拉斯罗伊米德尔塞克斯综合医院，这是一家农村社区医院，每年约有20000人次的急诊科就诊。
总共2000例连续的急诊科就诊病例，包括成人和儿童患者。试验组由急诊科有住院医师在场时就诊的患者组成。对照组由急诊科无住院医师在场时就诊的患者组成。
研究了22种不同类别的常见急诊科检查。
22类检查中的19类在研究组之间无统计学显著差异。有3类存在显著差异：急诊科无住院医师时就诊的患者D - 二聚体检测数量增加（1.7%的患者 vs 0.5%的患者，P = 0.03），以及急诊科有住院医师时就诊的患者计算机断层扫描和超声检查增加（分别为4.8% vs 1.8%，P = 0.0012，以及5.3%和1.7%，P < 0.001）。这些差异可能并非由于住院医师的参与，而是由组间检查可用性的差异所解释。
对于大多数研究的检查类别，该研究的效能不足。然而，本研究中显示的趋势表明，农村社区急诊科家庭医学住院医师的存在不会对诊断检查的总体使用产生实质性影响。
