急诊科门诊转诊的健康记录审查

A Health Records Review of Outpatient Referrals from the Emergency Department.

作者信息

Prudhomme Nicholas, Kwok Edmund S H, Olejnik Laura, White Shannon, Thiruganasambandamoorthy Venkatesh

机构信息

Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.

Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.

出版信息

Emerg Med Int. 2019 Oct 31;2019:5179081. doi: 10.1155/2019/5179081. eCollection 2019.

DOI:10.1155/2019/5179081

PMID:31781397

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6875006/

Abstract

OBJECTIVES

Many patients discharged home from the emergency department (ED) require urgent outpatient consultation with a specialty service. We sought to identify the best- and worst-performing services with regard to time to outpatient consultation, the proportion of patients lost to follow-up, the rate of related return ED visits prior to consultation, and common strategies used by our top-performing clinics.

METHODS

We conducted a health records review of The Ottawa Hospital ED visits during four 1-week periods. All consecutive adult outpatient consultation requests were included for chart review and were followed up to 12 months. Outcome measures included demographics, referral attendance rates, incomplete referrals, return ED visits, and time intervals. Services with at least 15 consultation requests were included for data analysis and qualitative mapping of their referral processes.

RESULTS

Of the 963 patients who met inclusion criteria, 803 (83.4%) attended their appointment, while 160 (16.6%) were lost to follow-up. The overall median time to successful consultation was 9 days (IQR = 2-27). 92 (9.6%) patients returned to the ED with a related complaint. The top-performing clinics included ophthalmology, orthopedics, and thrombosis (median = 1, 8, 1 days; incomplete consultation = 3%, 4%, 6%; return ED visits = 0%, 6%, 2% respectively). The bottom-performing clinics included otorhinolaryngology, neurology, and gynecology (median = 47, 39, 27 days; incomplete consultation = 50%, 41%, 37%; return ED visits = 11%, 15%, 26%, respectively). Processes incorporated by top-performing clinics included reserving appointment slots for emergency referrals, structured referral forms, and centralized booking.

CONCLUSIONS

We found a substantial variability in both the waiting times and reliability of outpatient referrals from the ED. Top-performing clinics incorporate common referral processes.

摘要

目的

许多从急诊科（ED）出院回家的患者需要紧急门诊专科会诊。我们试图确定在门诊会诊时间、失访患者比例、会诊前相关急诊复诊率以及表现最佳的诊所所采用的常见策略方面表现最佳和最差的科室。

方法

我们对渥太华医院在四个为期1周的时间段内的急诊就诊记录进行了回顾。所有连续的成人门诊会诊请求均纳入病历审查，并随访12个月。结果指标包括人口统计学特征、转诊就诊率、未完成的转诊、急诊复诊以及时间间隔。至少有15次会诊请求的科室纳入数据分析，并对其转诊流程进行定性分析。

结果

在符合纳入标准的963例患者中，803例（83.4%）就诊，160例（16.6%）失访。成功会诊的总体中位时间为9天（四分位间距=2-至27天）。92例（9.6%）患者因相关主诉返回急诊。表现最佳的科室包括眼科、骨科和血栓科（中位时间分别为1天、8天、1天；未完成会诊的比例分别为3%、4%、6%；急诊复诊率分别为0%、6%）。表现最差的科室包括耳鼻喉科、神经内科和妇科（中位时间分别为47天、39天、27天；未完成会诊的比例分别为50%、41%、37%；急诊复诊率分别为11%、15%、26%）。表现最佳的科室所采用的流程包括为紧急转诊预留预约时段、结构化转诊表格和集中预约。