Haasz Maya, Ostro Daniel, Scolnik Dennis
Department of Pediatrics, Mackenzie Richmond Hill Hospital, Richmond Hill.
Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Pediatr Emerg Care. 2018 Sep;34(9):647-649. doi: 10.1097/PEC.0000000000001598.
High patient volumes have a deleterious effect on care in the pediatric emergency department (PED). Our study assessed the motivation for PED visits that could have been assessed by a primary care physician.
We identified a convenience sample of patients presenting to the SickKids Hospital PED in June and July 2011 with a Paediatric Canadian Triage and Acuity Score 4 or 5. Patients completed a forced answer yes/no survey describing potential motivators for visiting the PED. Visit appropriateness was determined by a modified version of the DeAngelis tool, an explicit criteria-based tool frequently used for this purpose.
Of the included 635 patients with Paediatric Canadian Triage and Acuity Score 4 and 5, 25% were truly inappropriate as per DeAngelis criteria. Of these, perceived expertise at the tertiary care hospital (93.1%) and ease of getting tests (80.8%) were the most common reasons behind PED presentation.
Patients presenting to our PED typically have primary care physicians; however, access to their physicians during off-hours and availability of off-site testing is limited. Public policy aimed at decreasing overcrowding in the PED should address these themes.
高患者流量对儿科急诊科（PED）的医疗服务有不利影响。我们的研究评估了那些本可由初级保健医生进行评估的前往PED就诊的动机。
我们确定了一个便利样本，即2011年6月和7月前往病童医院PED就诊、儿科加拿大分诊及 acuity 评分 为4或5的患者。患者完成了一项强制回答“是”或“否”的调查，描述前往PED就诊的潜在动机。就诊适宜性由DeAngelis工具的修改版确定，这是一种常用于此目的的基于明确标准的工具。
在纳入的635名儿科加拿大分诊及 acuity 评分为4和5的患者中，根据DeAngelis标准，25%的就诊确实不合适。其中，认为三级医院专业（93.1%）和检查方便（80.8%）是前往PED就诊的最常见原因。
前来我们PED就诊的患者通常有初级保健医生；然而，非工作时间看医生的机会以及院外检查的可及性有限。旨在减少PED过度拥挤的公共政策应解决这些问题。
