Emergency Department, Manchester Royal Infirmary, Manchester, UK.
Emerg Med J. 2020 Dec;37(12):738-743. doi: 10.1136/emermed-2018-208388. Epub 2019 Jul 31.
This study aimed to investigate and collate the opinions of experts regarding the triage of patients in mental health crisis presenting to EDs.
A three-round e-Delphi study was conducted between November 2017 and April 2018. The panel of 28 representative experts were drawn from six stakeholder groups. 23 of the panel were clinicians working in England, while 5 were international triage experts.
Experts generated 173 statements in six topic areas in the first round. 32 of these statements reached consensus in round 2. A further 20 statements reached consensus in round 3, leaving 121 statements that did not reach consensus. The consensus statements were used to develop a structured five-level triage tool where the highest level of priority was assigned to patients exhibiting extreme aggression or agitation, those requiring restraint, those at immediate risk of leaving before assessment and those who presented a high risk of self-harm or harm to others. At lower triage priorities, other factors, such as items of psychiatric history, collateral history, observations and judgements, have been identified.
A broadly based, multispecialty, multiprofessional expert Delphi panel has reached consensus on 52 statements concerning the triage of patients presenting in mental health crisis to EDs. The triage tool derived from this work can be used to inform the design of triage instruments employed to prioritise patients with physical and mental health problems equitably.
本研究旨在调查和整理专家对急诊精神危机患者分诊的意见。
2017 年 11 月至 2018 年 4 月期间进行了三轮电子德尔菲研究。该小组由来自六个利益相关者群体的 28 名代表性专家组成。小组中的 23 名专家是在英格兰工作的临床医生，5 名是国际分诊专家。
专家们在第一轮的六个主题领域提出了 173 条意见。其中 32 条意见在第二轮达成共识。在第三轮又有 20 条意见达成共识，剩下 121 条意见未达成共识。共识意见被用来制定一个结构化的五级分诊工具，其中最高优先级分配给表现出极度攻击或激动、需要约束、有立即在评估前离开风险和有高自残或伤害他人风险的患者。在较低的分诊优先级下，还确定了其他因素，如精神病史、旁证病史、观察和判断。
一个基础广泛、多专业、多专业的专家德尔菲小组就急诊精神危机患者分诊的 52 条意见达成了共识。由此产生的分诊工具可用于为有身体和心理健康问题的患者设计公平优先排序的分诊工具。
