意大利的儿科急诊室活动：一项全国性调查。
Pediatric emergency room activities in Italy: a national survey.
作者信息
Longhi Riccardo, Picchi Raffaella, Minasi Domenico, Di Cesare Merlone Alessandra
机构信息
Unità Operativa di Pediatria, Ospedale Sant'Anna, San Fermo della Battaglia, Como, Italy.
Unità Operativa di Pediatria, Ospedale di Polistena, Reggio Calabria, Italy.
出版信息
Ital J Pediatr. 2015 Oct 15;41:77. doi: 10.1186/s13052-015-0184-9.
BACKGROUND
In Italy, the number of accesses to the Emergency Units has been growing for the past 30 years. This, together with a low coordination between hospital and peripheral pediatric services, has brought to an unnecessarily high number of hospital admissions. For this reason, it is essential to plan and implement strategies able to improve the appropriateness of hospital admissions. In the '90s, the Short Stay Observation was extended to pediatric patients. As highlighted by the report "Guidelines for Pediatric Observation Units" (2005), patients receive considerable benefits from a short hospital permanence. The purpose of the study is to report data about the Pediatric Emergency Room activities in Italy.
METHODS
In 2011, the Italian Society of Pediatrics promoted an online data collection to investigate organization and activity of Italian Pediatric and Neonatal Units. A form, containing 140 questions, was sent to 624 Pediatric and Neonatology Units. This study will be focused only on data regarding pediatric Emergency Rooms (E.R.) and Observation Units.
RESULTS
237 units replied, 183 if we focus on units with pediatric inpatient service. Based on the results, E.R Units were provided with a dedicated pediatrician in 56 % of the cases: of these, 85 % for 24 h. The majority of the patients were seen by a pediatrician. In only 8 % of the units, patients visited by a pediatrician were less than 40 %. The age limit was 14 years in 60 % of the cases. In 72 % of participating units a E.R. triage was carried out. Only 18 % of units registered more than 10000 E.R. visits/year. The percentage of children hospitalized after accessing the E.R. was significantly higher in southern regions (more than 20 % of the units hospitalized more than 40 % of children entering the E.R.). 66 % of the units were provided with an Observation Unit. In 61 % of the cases, the duration did not exceed 24 h. In more than half of the structures, less than 10 % of the E.R. visits went into observation. The type of remuneration was not homogeneous.
CONCLUSIONS
The study highlights the heterogeneity of the Italian reality, with great possibilities for improvement, especially in southern regions.
背景
在意大利，过去30年中急诊科室的就诊人数一直在增长。这一点，再加上医院与周边儿科服务之间协调性欠佳，导致不必要的高住院人数。因此，规划并实施能够提高住院合理性的策略至关重要。在20世纪90年代，短期住院观察被扩展到儿科患者。正如《儿科观察病房指南》（2005年）报告所强调的，患者从短期住院中受益匪浅。本研究的目的是报告意大利儿科急诊室活动的数据。
方法
2011年，意大利儿科学会发起了一项在线数据收集活动，以调查意大利儿科和新生儿科室的组织与活动情况。一份包含140个问题的表格被发送给624个儿科和新生儿科室。本研究将仅聚焦于有关儿科急诊室（E.R.）和观察病房的数据。
结果
237个科室回复了问卷，如果只关注设有儿科住院服务的科室，则有183个科室回复。根据结果，56%的急诊室配备了专职儿科医生：其中，85%的儿科医生提供24小时服务。大多数患者由儿科医生诊治。只有8%的科室中，由儿科医生诊治的患者不到40%。60%的情况下年龄限制为14岁。72%的参与科室进行了急诊分诊。只有18%的科室每年急诊就诊人数超过10000人次。在南部地区，进入急诊室后住院的儿童比例显著更高（超过20%的科室中，超过40%进入急诊室的儿童住院）。66%的科室设有观察病房。61%的情况下，观察时间不超过24小时。在一半以上的机构中，不到10%的急诊就诊患者进入观察病房。薪酬类型并不统一。
结论
该研究突出了意大利实际情况的异质性，有很大的改进空间，尤其是在南部地区。
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