Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France.
Université Paris-Est Créteil (UPEC), EA-4390 (Analysis of Risk in Complex Health Systems, ARCHeS), Créteil, France.
BMC Health Serv Res. 2019 Jul 30;19(1):531. doi: 10.1186/s12913-019-4350-4.
In France, general practitioners (GPs) perform out-of-hours home visits (OOH-HVs) after physician-led telephone triage at the emergency call centre. The quality of a systematic physician-led triage has not been determined in France and may affect the efficiency of the OOH-HV process. The objectives of this study were first, to evaluate the quality of reporting in the electronic patient's file after such triage and second, to analyse the factors associated with altered reporting.
Cross-sectional study in a French urban emergency call centre (district of Paris area) from January to December 2015. For a random selection of 30 days, data were collected from electronic medical files that ended with an OOH-HV decision. Missing key quality criteria (medical interrogation, diagnostic hypothesis or ruled-out severity criteria) were analysed by univariate then multivariate logistic regression, adjusted on patient, temporal and organizational data.
Among 10,284 OOH-HVs performed in 2015, 748 medical files were selected. Reasons for the encounter were digestive tract symptoms (22%), fever (19%), ear nose and throat symptoms, and cardiovascular and respiratory problems (6% each). Medical interrogation was not reported in 2% of files (n = 16/748) and a diagnostic hypothesis in 58% (n = 432/748); ruled-out severity criteria were not reported in 60% (n = 449/748). On multivariate analysis, altered reporting was related to the work overload of triage assistants (number of incoming calls, call duration, telephone occupation rate; p < 0.03).
In the electronic files of patients requiring an OOH-HV by a GP in a French urban area, quality in medical reporting appeared to depend on organizational factors only, especially the triage assistants-related work factors. Corrective measures are needed to ensure good quality of triage and care.
在法国，家庭医生（GP）在紧急呼叫中心的医生主导的电话分诊后进行非工作时间的上门就诊（OOH-HV）。法国尚未确定系统的医生主导分诊的质量，而这可能会影响 OOH-HV 流程的效率。本研究的目的首先是评估这种分诊后电子患者档案中的报告质量，其次是分析与改变报告相关的因素。
这是一项 2015 年 1 月至 12 月在法国城市紧急呼叫中心（巴黎地区）进行的横断面研究。随机选择 30 天的数据，从以 OOH-HV 决策结束的电子病历中收集。通过单变量和多变量逻辑回归分析，对缺失关键质量标准（医学询问、诊断假设或排除的严重程度标准）进行分析，调整患者、时间和组织数据。
2015 年共进行了 10284 次 OOH-HV，其中有 748 份医疗记录被选中。就诊的原因是消化道症状（22%）、发热（19%）、耳鼻喉症状以及心血管和呼吸系统问题（各占 6%）。2%的病历（16/748）未报告医学询问，58%（432/748）的病历未报告诊断假设；60%（449/748）的病历未报告排除的严重程度标准。多变量分析显示，改变报告与分诊助手的工作负荷有关（来电数量、通话时间、电话占用率；p<0.03）。
在法国城市地区需要由家庭医生进行 OOH-HV 的患者的电子档案中，医疗报告的质量似乎仅取决于组织因素，尤其是与分诊助手相关的工作因素。需要采取纠正措施，以确保分诊和护理的高质量。
