Harari Sanderovich Idit, Barkan Shiri, Kozer Eran
Pediatric Emergency Unit, Assaf Harofeh Medical Center affiliated with the Sackler Faculty of Medicine , Tel Aviv University.
Harefuah. 2018 May;157(5):283-286.
Referral notes are the main communication method between primary physicians and hospital physicians. Therefore, the written referral, has great importance in explaining the patient's condition or complaint, and the additional steps or actions that may be required for their complete evaluation and diagnosis. In this research we evaluated the main reasons for child referral to the hospital and, whether both the hospital physician and the child's parents understood those reasons correctly.
All the children referred to the ED during four weeks in July 2013 were included. For all cases with referral notes three questionnaires were presented: One to the hospital physician, one to the child's parents and a third, (via phone conversation), to the referring physician.
At least two questionnaires were completed for each of the 261 cases. When primary physicians' original goals were compared with the hospital physicians' interpretation, only 33.7% of cases were fully matched, in 24.8% of cases there was a partial match and in 41.6% there was no match at all. When primary physicians' original goals were compared with the parents' understanding only 35.5% showed that they were fully matched, 30.3% showed partial match and 34.2% show no match at all. When evaluating primary physicians' intention with hospital physicians' interpretation, we found that during on-call hours the probability for a match was lower. Matching was higher for more experienced primary physicians.
This research reinforces the impression of many hospital physicians of misunderstanding referral goals. Over 65% of referrals were partially or totally misunderstood. These findings are of importance when evaluating a sick child, since the community doctor usually has a greater acquaintance with the patient's condition gathered over the years or during an acute illness.
转诊记录是基层医生与医院医生之间的主要沟通方式。因此，书面转诊记录在解释患者病情或主诉以及进行全面评估和诊断可能需要的额外步骤或行动方面具有重要意义。在本研究中，我们评估了儿童转诊至医院的主要原因，以及医院医生和儿童家长是否正确理解了这些原因。
纳入2013年7月四周内转诊至急诊科的所有儿童。对于所有有转诊记录的病例，发放三份问卷：一份给医院医生，一份给儿童家长，第三份（通过电话交谈）给转诊医生。
261例病例中的每一例至少完成了两份问卷。将基层医生的原始目标与医院医生的解读进行比较时，只有33.7%的病例完全匹配，24.8%的病例部分匹配，41.6%的病例完全不匹配。将基层医生的原始目标与家长的理解进行比较时，只有35.5%的家长表示完全匹配，30.3%的家长表示部分匹配，34.2%的家长表示完全不匹配。在评估基层医生的意图与医院医生的解读时，我们发现值班期间匹配的可能性较低。经验更丰富的基层医生匹配度更高。
本研究强化了许多医院医生对转诊目标存在误解的印象。超过65%的转诊被部分或完全误解。这些发现对于评估患病儿童很重要，因为社区医生通常对患者多年来或急性疾病期间的病情更为了解。
