Ellbrant Julia, Åkeson Jonas, Åkeson Pia Karlsland
From the Department of Clinical Sciences Malmö, *Anesthesiology and Intensive Care Medicine, and †Pediatrics, Lund University, Skåne University Hospital, Malmö, Sweden.
Pediatr Emerg Care. 2015 Feb;31(2):95-100. doi: 10.1097/PEC.0000000000000348.
Overcrowding at pediatric emergency departments (EDs) may result in delayed clinical management and higher risks of medical error. This study was designed to prospectively evaluate what parents of sick children seek emergency care for and how these patients are being assessed and managed.
Patients aged 0 to 17 years seeking ED care at an urban Swedish university hospital, from 8 AM to 9 PM on 25 consecutive days, were included. Clinical urgency and further level of medical care were determined by experienced nurses based on individual clinical signs and vital parameters. Information on presenting problem, medical priority, gender, age, waiting time, day of week, time of day, and further management was recorded.
Among 1057 included children, two thirds were assessed by physicians, whereas one third were referred directly by nurses for other ED (n = 54) or primary care (n = 114), or sent home with medical advice (n = 176), more often during evenings and weekends. Of primarily referred patients, 7.6% returned within 72 hours, and three of them were admitted. Young infants, patients with respiratory or neurological problems, and sicker patients with fever or infections were mainly assessed by physicians, within desired priority time.
More than one fourth of pediatric ED patients might rapidly, appropriately, and safely be referred for primary care or sent home by experienced pediatric nurses soon after arrival, thereby facilitating management of urgent and more appropriate patients. Evaluations by physicians were primarily required in young infants and for urgent medical conditions demanding qualified pediatric skills.
儿科急诊科过度拥挤可能导致临床治疗延迟和医疗差错风险增加。本研究旨在前瞻性评估患病儿童的家长寻求急诊治疗的原因，以及这些患者是如何接受评估和治疗的。
纳入连续25天上午8点至晚上9点在瑞典一家城市大学医院急诊科就诊的0至17岁患者。由经验丰富的护士根据个体临床体征和生命体征参数确定临床紧急程度和进一步的医疗护理级别。记录有关就诊问题、医疗优先级、性别、年龄、等待时间、星期几、一天中的时间以及进一步治疗的信息。
在纳入的1057名儿童中，三分之二由医生进行评估，而三分之一由护士直接转诊至其他急诊科（n = 54）或初级保健机构（n = 114），或在获得医疗建议后回家（n = 176），这种情况在晚上和周末更为常见。在主要被转诊的患者中，7.6%在72小时内返回，其中3人被收治。小婴儿、患有呼吸或神经问题的患者以及病情较重的发热或感染患者主要由医生在期望的优先时间内进行评估。
超过四分之一的儿科急诊科患者在到达后不久可能会被经验丰富的儿科护士迅速、适当地且安全地转诊至初级保健机构或送回家，从而便于管理紧急且更合适的患者。对于小婴儿以及需要具备合格儿科技能的紧急医疗状况，主要需要医生进行评估。
