Department of Emergency Medicine, University of British Columbia, c/o Vancouver General Hospital Emergency Research Office, Vancouver, British Columbia, Canada
Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Inj Prev. 2019 Dec;25(6):507-513. doi: 10.1136/injuryprev-2018-042958. Epub 2018 Oct 18.
Injury prevention should be informed by timely surveillance data. Unfortunately, most injury surveillance only captures patients with severe injuries and is not available in real time, hampering prevention efforts. We aimed to develop and pilot a simple injury surveillance strategy that can be integrated into routine emergency department (ED) workflow to collect more robust mechanism of injury information at time of visit for all injured ED patients with minimal impact on workflow.
We reviewed ED injury surveillance systems and considered ED workflow. Forms were developed to collect injury-related information on ED patients and refined to address workload concerns raised by key stakeholders. Research assistants observed ED staff as they registered injured patients and noted the time required to collect data and any ambiguities or concerns encountered. Interobserver agreement was recorded.
Injury surveillance questions were based on a modification of the International Classification of External Causes of Injury. Research assistants observed 222 injured patients being admitted by registration clerks. The mean time required to complete the surveillance form was 64.9 s (95% CI 59.9 s to 69.9 s) for paper-based forms (120 cases) and 44.5 s (95% CI 41.7s to 47.4s) with direct electronic data entry (102 cases). Interobserver agreement (26 cases) was 100% for intent (kappa=1.0) of injury and 96% for mechanism of injury (kappa=0.74).
We report a simple injury surveillance strategy that ED staff can use to collect meaningful injury data in real time with minimal impact on workflow. This strategy can be adapted to enhance regional injury surveillance efforts.
伤害预防应基于及时的监测数据。不幸的是，大多数伤害监测仅捕获严重受伤的患者，且无法实时获得，从而阻碍了预防工作的开展。我们旨在开发并试点一种简单的伤害监测策略，该策略可以整合到常规急诊部（ED）工作流程中，以便在所有受伤 ED 患者就诊时收集更全面的损伤机制信息，同时对工作流程的影响最小。
我们回顾了 ED 伤害监测系统并考虑了 ED 工作流程。制定了表格以收集 ED 患者的伤害相关信息，并进行了改进以解决主要利益相关者提出的工作量问题。研究助理观察 ED 工作人员为受伤患者登记的过程，并记录收集数据所需的时间以及遇到的任何歧义或问题。记录了观察者间的一致性。
伤害监测问题基于对国际伤害外部原因分类的修改。研究助理观察了 222 名由注册员收治的受伤患者。使用纸质表格（120 例）完成监测表所需的平均时间为 64.9 秒（95%置信区间 59.9 秒至 69.9 秒），直接电子数据录入（102 例）所需的平均时间为 44.5 秒（95%置信区间 41.7 秒至 47.4 秒）。观察者间的一致性（26 例）对于伤害意向（kappa=1.0）为 100%，对于损伤机制（kappa=0.74）为 96%。
我们报告了一种简单的伤害监测策略，ED 工作人员可以使用该策略实时收集有意义的伤害数据，同时对工作流程的影响最小。该策略可以进行调整，以加强区域伤害监测工作。
