NYU Langone Headache Center, New York, NY, USA.
City College, CUNY, New York, NY, USA.
Headache. 2018 Oct;58(9):1389-1396. doi: 10.1111/head.13387. Epub 2018 Sep 12.
Emergency department (ED) visits for migraine are burdensome to patients and to the larger healthcare system and society. Thus, it is important to determine strategies used to prevent ED visits and the common communication patterns between headache specialists and the ED team.
We sought to understand: (1) Whether headache specialists use headache management protocols. (2) The strategies they use to try and reduce the number of ED visits for headache. (3) Whether protocols are used in the EDs with which they are affiliated. (4) The level of satisfaction with the coordination of care between headache physicians and the ED.
We surveyed via SurveyMonkey members of the American Headache Society Emergency Department/Refractory/Inpatient (EDRI) Section to understand their practice regarding patients who call their office to be seen urgently, and to understand their communication with their local EDs.
There were 96 eligible AHS members, 50 of whom responded to questionnaires either by email or in person (52%). Of these, 59% of respondents reported giving rescue treatment to their patients to manage acute attacks. Fifty-four percent reported using standard protocols for outpatients not responding to usual acute treatments. In the event of a request for urgent care, 12% of specialists reported bringing patients into the office most or all of the time, and 20% reported sending patients to the ED some or most of the time for headache management. Thirty-six percent reported prescribing a new medicine and 30% reported providing telephone counseling some/most/all of the time. Sixty percent reported that their ED has a protocol for migraine management. Overall, 38% were usually or very satisfied with the headache care in the ED.
A substantial number of headache specialists are dissatisfied with the care their patients receive in the ED. More standardized protocols for ED visits by patients with known headache disorders, and clear guidelines for communication between ED providers and treating physicians, along with better methods for follow-up following discharge from the ED, might appear to improve this issue.
偏头痛患者前往急诊部（ED）就诊，给患者和整个医疗保健系统及社会带来了沉重负担。因此，确定预防 ED 就诊的策略以及头痛专家与 ED 团队之间的常见沟通模式非常重要。
我们旨在了解：（1）头痛专家是否使用头痛管理方案；（2）他们尝试减少头痛 ED 就诊次数的策略；（3）他们所属的 ED 是否使用方案；（4）头痛医师与 ED 之间的护理协调满意度。
我们通过 SurveyMonkey 向美国头痛协会急诊/难治性/住院部（EDRI）分会的成员进行了调查，以了解他们对紧急就诊患者的实践情况，以及了解他们与当地 ED 的沟通情况。
共有 96 名合格的 AHS 成员，其中 50 名通过电子邮件或亲自回复了调查问卷（52%）。在这些人中，59%的受访者报告说，他们给患者使用急救治疗来管理急性发作。54%的受访者报告说，他们对未对常规急性治疗有反应的门诊患者使用标准方案。在紧急就诊请求时，12%的专家报告说，他们大多数或所有时间都将患者带到办公室，20%的专家报告说，他们将患者送到 ED 治疗头痛，有些或大多数时间。36%的专家报告说，他们开了新药，30%的专家报告说他们经常或大多数时间都提供电话咨询。60%的专家报告说，他们的 ED 有偏头痛管理方案。总的来说，38%的专家对 ED 治疗头痛的护理基本或非常满意。
相当数量的头痛专家对患者在 ED 接受的护理不满意。更多针对已知头痛疾病患者的 ED 就诊标准化方案，以及 ED 提供者与治疗医生之间沟通的明确指南，以及更好的 ED 出院后随访方法，可能会改善这一问题。
