由护士主导的吞咽困难热线服务改善了临床结局和疗效。
Improved clinical outcomes and efficacy with a nurse-led dysphagia hotline service.
作者信息
Murray Iain Alexander, Waters Carolyn, Maskell Giles, Despott Edward J, Palmer Joanne, Dalton Harry R
机构信息
Department of Gastroenterology, Royal Cornwall Hospitals NHS Trust, Truro, Cornwall, UK.
Department of Clinical Imaging, Royal Cornwall Hospitals NHS Trust, Truro, Cornwall, UK.
出版信息
Frontline Gastroenterol. 2013 Apr;4(2):102-107. doi: 10.1136/flgastro-2012-100244. Epub 2012 Dec 14.
BACKGROUND
A nurse practitioner-led dysphagia service was introduced to improve appropriateness of investigations.
OBJECTIVE
To determine the clinical outcomes and efficacy of this service.
DESIGN AND PATIENTS
A 7-year prospective audit of the first 2000 patients referred for investigation of dysphagia.
SETTING
Royal Cornwall Hospitals NHS Trust.
INTERVENTION
An innovative nurse practitioner-led telephone dysphagia hotline (DHL) assessment service for all patients and consultant review following investigation prior to discharge.
OUTCOMES
Clinical outcomes, service efficiency and cost effectiveness.
RESULTS
2000 patients (median age 70 years, 48% male) were referred in less than 7 years, 1775 being managed fully through the DHL. 67% patients had gastroscopy only, 13% barium swallow only and 8.8% both and 11.2% had no investigation. Reflux was the commonest cause (41.3%), 9% had peptic stricture, 10% malignancy 1.9% pharyngeal pouches and 0.8% achalasia. The did not attend rate was reduced from 3.9% to 1.1% and 151 patients either refused or did not require investigation saving a potential £53 040. Although some patients with pharyngeal pouches had gastroscopy as initial investigation, no complications resulted.
CONCLUSIONS
The nurse practitioner-led DHL service has improved efficiency and resulted in a safe prompt service to patients.
背景
引入了由执业护士主导的吞咽困难服务，以提高检查的合理性。
目的
确定该服务的临床结果和疗效。
设计与患者
对前2000例因吞咽困难转诊接受检查的患者进行为期7年的前瞻性审计。
地点
皇家康沃尔郡国民保健服务信托基金。
干预措施
为所有患者提供由创新的执业护士主导的电话吞咽困难热线（DHL）评估服务，并在出院前检查后由顾问进行复查。
结果
临床结果、服务效率和成本效益。
结果
在不到7年的时间里转诊了2000例患者（中位年龄70岁，48%为男性），其中1775例通过DHL得到了全面管理。67%的患者仅接受了胃镜检查，13%仅接受了吞钡检查，8.8%两者都接受了检查，11.2%未接受检查。反流是最常见的原因（41.3%），9%患有消化性狭窄，10%患有恶性肿瘤，1.9%患有咽袋，0.8%患有贲门失弛缓症。未到诊率从3.9%降至1.1%，151例患者拒绝或不需要检查，节省了潜在的53040英镑。尽管一些患有咽袋的患者最初接受了胃镜检查，但未出现并发症。
结论
由执业护士主导的DHL服务提高了效率，并为患者提供了安全、及时的服务。
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