影响急诊呼叫中心电话分诊时医疗档案记录的因素：法国全科医生非工作时间上门就诊的横断面研究。

Factors affecting medical file documentation during telephone triage at an emergency call centre: a cross-sectional study of out-of-hours home visits by general practitioners in France.

机构信息

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.

出版信息

BMC Health Serv Res. 2019 Jul 30;19(1):531. doi: 10.1186/s12913-019-4350-4.

DOI:10.1186/s12913-019-4350-4

PMID:31362748

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6668156/

Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSION

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.

摘要

背景

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。

方法

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。

结果

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）。