Iezzoni Lisa I, Kothari Dhruva, Camargo Carlos A, Wint Amy J, Cluett W Scott, Tripodis Yorghos, Palmisano Joseph
1 Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, MA.
2 Department of Medicine, Harvard Medical School, Boston, MA.
Am J Med Qual. 2019 Jul/Aug;34(4):331-338. doi: 10.1177/1062860618800582. Epub 2018 Sep 19.
The Acute Community Care Program (ACCP) initiative sends specially trained paramedics to evaluate and treat patients with urgent care problems in their residences during evening hours. ACCP safety depends on making appropriate triage decisions from patients' reports during phone calls about whether paramedics could care for patients' urgent needs or whether they require emergency department (ED) services. Furthermore, after ACCP paramedics are on scene, patients may nonetheless need ED care if their urgent health problems are not adequately treated by the paramedic's interventions. To train clinical staff participating in all aspects of ACCP, including these triage decisions, ACCP clinical leaders developed brief vignettes: 27 represented initial ACCP triage decisions and 10 the subsequent decision to send patients to EDs. This report describes findings from an online survey completed by 24 clinical staff involved with ACCP triage. Clinical vignettes could be useful for staff training and quality control in such paramedic initiatives.
急性社区护理计划（ACCP）项目派遣经过专门培训的护理人员，在晚间时段前往患者家中，对有紧急护理问题的患者进行评估和治疗。ACCP的安全性取决于护理人员通过电话中患者的报告，做出恰当的分诊决定，判断护理人员能否满足患者的紧急需求，还是患者需要急诊部门（ED）的服务。此外，ACCP护理人员到达现场后，如果患者的紧急健康问题没有通过护理人员的干预得到充分治疗，患者仍可能需要急诊护理。为了培训参与ACCP各个环节的临床工作人员，包括这些分诊决定，ACCP的临床负责人编写了简短的病例 vignettes：27个代表ACCP最初的分诊决定，10个代表随后将患者送往急诊室的决定。本报告描述了参与ACCP分诊的24名临床工作人员完成的在线调查结果。临床病例 vignettes 对于此类护理人员项目中的员工培训和质量控制可能有用。 （注：这里的“vignettes”直接保留英文，因为在中文语境中可能没有完全对应的准确词汇，它在原文中有特定含义，指简短的病例描述之类的内容）
