Soragna Giorgio, Bermond Francesca, Fabbrini Laura, Rodofili Amelia, Soragna Aldo, Bauducco Maggiorina, Panunzi Aspasia, Ramondetti Ada, Cerri Cristiana, Vitale Corrado
SC Nefrologia e Dialisi, AO Ordine Mauriziano di Torino, Italia.
G Ital Nefrol. 2018 Mar;35(2).
The clinical course of outpatients with advanced chronic kidney disease requires a close monitoring by the nephrology team, in order to identify emerging clinical problems promptly and prevent subsequent complications. With the aim of improving the outpatient management in our clinic dedicated to advanced renal failure, we implemented the "Nephrology Clinic Triage" (NCT). This organizational model is coordinated by the nephrologist and supported by nurses. In case the outpatients, or their caregivers, have clinical problems or need advice, they can easily get in touch with a nephrology nurse by a dedicated telephone line. The nurse, who had been specifically trained for this purpose, interviews the patient by telephone and track his health conditions using dedicated flow-charts. The patients must be able to answer in a suitable way to the telephone interview on which NCT is based. Therefore, all patients referring to nephrology clinic are trained to record and report properly by telephone some relevant clinical parameters (i.e., blood pressure, body temperature, heart rate, body weight, urine volume) and clinical signs (dyspnea, dysuria, diarrhea, nausea, vomiting, abdominal/lumbar/chest pain). On the basis of the information obtained by means of NCT, the nurse can identify the patient's need and classify its severity and priority by means of a color-coding system. The subsequent medical intervention (telephone conversation, scheduled appointment, hospitalization) is planned accordingly. The implementation of NCT may be useful to monitor the clinical course of outpatients with advanced chronic renal failure also when they are home, thereby reducing the risk of harmful complications and hospitalization.
晚期慢性肾脏病门诊患者的临床病程需要肾脏病团队密切监测，以便及时发现新出现的临床问题并预防后续并发症。为了改善我们诊所对晚期肾衰竭患者的门诊管理，我们实施了“肾脏病门诊分诊”（NCT）。这种组织模式由肾脏病医生协调，护士提供支持。如果门诊患者或其护理人员有临床问题或需要建议，他们可以通过专用电话线轻松联系到肾脏病护士。为此经过专门培训的护士通过电话对患者进行访谈，并使用专用流程图跟踪其健康状况。患者必须能够以合适的方式回答作为NCT基础的电话访谈。因此，所有转诊至肾脏病门诊的患者都接受培训，以便通过电话正确记录和报告一些相关临床参数（即血压、体温、心率、体重、尿量）和临床症状（呼吸困难、排尿困难、腹泻、恶心、呕吐、腹部/腰部/胸痛）。根据通过NCT获得的信息，护士可以确定患者的需求，并通过颜色编码系统对其严重程度和优先级进行分类。随后据此安排相应的医疗干预措施（电话沟通、预约就诊、住院治疗）。NCT的实施对于监测晚期慢性肾衰竭门诊患者在家时的临床病程可能也很有用，从而降低有害并发症和住院的风险。
