Unità Locale Socio Sanitaria 2 "Marca Trevigiana", Treviso, Continuità Assistenziale di Vittorio Veneto (TV), Vittorio Veneto (TV), Italy.
Scuola di Formazione Specifica in Medicina Generale, Regione Veneto, Venice, Italy.
Intern Emerg Med. 2018 Jun;13(4):549-555. doi: 10.1007/s11739-017-1679-8. Epub 2017 May 25.
Out of hours (OOH) doctors can have an important gate-keeping role over the access to the emergency department (ED), but the outcome and the quality of their ED referrals have been poorly studied. We aimed to investigate the outcome of patients referred to ED from OOH service and the determinants of admission or short-stay dispositions. We collected retrospectively data about referrals to ED from a local OOH service in the north-east of Italy using the OOH paper register and the ED electronic database, over the period of 01/10/2012 to 31/03/2013. Out of 5217 patients accessing the OOH service, 408 referrals were included in our analysis. 45.3% (185) of the referrals were admitted to hospital or the short-stay unit, 26 patients (=6.4%) were discharged as non-urgent outgoing codes after no specialist consultation or test, suggesting inappropriate referrals, and, of the remaining 197 (=48%), only 10 did not undergo any investigation or consultation. Significant determinants of admission were: age ≥65 years (OR = 2.619; 95% CI 1.528-4.491, p < 0.0001), domiciliary examination (OR = 2.168; 95% CI 1.353-3.476, p = 0.001), nursing home/palliative care setting (OR = 2.563; 95% CI 1.228-5.351, p = 0.012) and OOH triage code, ranging from an OR of 7.47 (95% CI 3.028-18.433) for minor urgencies to an OR of 26.835 (95% CI 6.761-106.508, p < 0.0001) for emergencies, in comparison to no urgent codes. OOH service seems to play an effective gate-keeping role limiting ED access. Determinants of admission to hospital suggest some simple interventions that could improve the adequacy of ED referral from OOH service.
非工作时间（OOH）医生可以在急诊部（ED）的就诊中发挥重要的把关作用，但他们的 ED 转诊结果和质量却研究得很差。我们旨在调查从 OOH 服务转至 ED 的患者的结局，以及确定收治或短期住院的决定因素。我们使用 OOH 纸质登记册和 ED 电子数据库，回顾性地收集了意大利东北部一个当地 OOH 服务在 2012 年 10 月 1 日至 2013 年 3 月 31 日期间向 ED 的转诊数据。在 5217 名访问 OOH 服务的患者中，有 408 例被纳入我们的分析。45.3%（185 例）的转诊患者被收治入院或短期住院病房，26 例患者（=6.4%）在未进行专科会诊或检查后，按非紧急出院代码出院，表明转诊不当，而在其余 197 例（=48%）中，只有 10 例未接受任何检查或会诊。收治入院的显著决定因素包括：年龄≥65 岁（OR=2.619；95%CI 1.528-4.491，p<0.0001）、家庭检查（OR=2.168；95%CI 1.353-3.476，p=0.001）、疗养院/姑息治疗环境（OR=2.563；95%CI 1.228-5.351，p=0.012）和 OOH 分诊代码，从轻微紧急情况的 OR 为 7.47（95%CI 3.028-18.433）到紧急情况的 OR 为 26.835（95%CI 6.761-106.508，p<0.0001），与无紧急代码相比。OOH 服务似乎在限制 ED 就诊方面发挥了有效的把关作用。收治入院的决定因素表明，一些简单的干预措施可以提高 OOH 服务向 ED 转诊的适当性。
