Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Emerg Med J. 2018 May;35(5):309-315. doi: 10.1136/emermed-2017-207149. Epub 2018 Mar 9.
The goal of this study was to determine if ED surge and end-of-shift assessment of patients affect the extent of diagnostic tests, therapeutic interventions and accuracy of diagnosis prior to referral to internal medicine.
This study was a health records review of consecutive patients referred to the internal medicine service with an ED diagnosis of heart failure, chronic obstructive pulmonary disease (COPD) or sepsis starting 1 December 2013 until 100 cases for each condition had been obtained. We developed a scoring system in consultation with emergency and internal medicine physicians to uniformly assess the completeness of treatments and investigations performed. These scores, expressed as percentage of possible points, were compared at high and low surge levels and at middle and end of shift at time of patient referral. End of shift was defined as 7:30-8:30, 15:30-16:30 and 23:30-00:30 as our shift changes occur at 8:00, 16:00 and 24:00. Rate of admission, diversion to other services and diagnosis disagreements were also assessed.
We included 308 patients (101 heart failure, 101 COPD, 106 sepsis) with a mean age of 74.7. Comparing middle of shift to end of shift, the mean scores were 91.9% versus 91.8% (difference 0.1% (95% CI -2.4 to 3.0)) for investigations and 73.0% versus 70.4% (difference 2.6% (95% CI -1.8 to 7.4)) for treatments. Comparing low to high surge times, the mean scores were 92.1% versus 91.7% (difference 0.4% (95% CI -1.2 to 2.4)) for investigations and 71.4% versus 73.6% (difference -2.2% (95% CI -5.6 to 1.3)) for treatments. We found low rates of diversion to alternate services (8.9% heart failure, 0% COPD, 6.6% sepsis) and low rates of diagnosis disagreement (4.0% heart failure, 10.9% COPD, 8.5% sepsis).
We found no evidence that surge levels and end of shift impact the extent of investigations and treatments provided to patients diagnosed in the ED with heart failure, COPD or sepsis and referred to internal medicine.
本研究旨在确定急诊就诊时的患者量增加和班次结束时对患者的评估是否会影响转至内科前诊断性检查、治疗干预措施的范围和诊断的准确性。
本研究回顾性分析了 2013 年 12 月 1 日至每个疾病组获得 100 例患者后，因心力衰竭、慢性阻塞性肺疾病（COPD）或脓毒症转至内科的连续患者的病历。我们与急诊和内科医生协商制定了一个评分系统，以统一评估治疗和检查的完整性。这些分数以可能分数的百分比表示，并在高和低就诊高峰时段以及患者转至内科时的班次中间和结束时进行比较。班次结束定义为 7:30-8:30、15:30-16:30 和 23:30-00:30，因为我们的班次变更发生在 8:00、16:00 和 24:00。还评估了入院率、转至其他科室的比例和诊断分歧。
我们纳入了 308 例患者（心力衰竭 101 例、COPD 101 例、脓毒症 106 例），平均年龄为 74.7 岁。与班次中间相比，班次结束时的检查平均分数分别为 91.9%和 91.8%（差值 0.1%（95%CI-2.4 至 3.0）），治疗的平均分数分别为 73.0%和 70.4%（差值 2.6%（95%CI-1.8 至 7.4））。与低就诊高峰相比，高就诊高峰时的检查平均分数分别为 92.1%和 91.7%（差值 0.4%（95%CI-1.2 至 2.4）），治疗的平均分数分别为 71.4%和 73.6%（差值-2.2%（95%CI-5.6 至 1.3））。我们发现转至其他科室的比例较低（心力衰竭 8.9%、COPD 0%、脓毒症 6.6%），诊断分歧的比例也较低（心力衰竭 4.0%、COPD 10.9%、脓毒症 8.5%）。
我们没有发现就诊高峰时段和班次结束会影响因心力衰竭、COPD 或脓毒症到急诊科就诊并转至内科的患者接受的检查和治疗的范围。
