Agor Joseph K, Sir Mustafa Y, Pasupathy Kalyan S, Foley David A, Scott Christopher G, Elrashidi Muhamad Y, Young Nathan P, McKie Paul M
School of Mechanical, Industrial, and Manufacturing Engineering, Oregon State University, Corvallis.
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
Mayo Clin Proc Innov Qual Outcomes. 2019 Oct 22;3(4):476-482. doi: 10.1016/j.mayocpiqo.2019.08.003. eCollection 2019 Dec.
To assess the impact of a triage system of emergency department (ED) referrals for outpatient cardiology appointments.
We implemented a triage system of ED referrals for outpatient cardiology appointments among patients with a cardiovascular chief complaint deemed safe to leave the ED but needing outpatient follow-up. There were 303 and 267 unique patients in the pre-triage implementation and post-triage implementation cohorts, respectively. We collected retrospective billing data to assess ED return visits, hospitalizations, cardiology outpatient visits, and cardiovascular testing. The pre-triage implementation cohort included patients with an ED visit date between January 1, 2014, and December 31, 2014. The post-triage implementation cohort included patients with an ED visit date between July 1, 2015, and June 30, 2016.
The triage model reduced the number of ED-referred cardiovascular service appointments by 73.0% (195 of 267 patients). Additionally, the "no-show" rate for appointments decreased from 17.8% (54 of 303 patients) to 7.9% (21 of 267 patients). There was no increase in ED return visits or unplanned hospitalizations in the posttriage cohort. Finally, the triage model was not associated with an increase in resource-intensive cardiovascular testing (eg, imaging stress tests or computed tomography).
Triage of ED referrals for outpatient cardiovascular service appointments reduced cardiology appointment utilization with no impact on return ED visits, hospitalizations, or cardiovascular testing.
评估急诊科（ED）转诊至门诊心脏病预约的分诊系统的影响。
我们对因心血管主诉就诊且被认为可安全离开急诊科但需要门诊随访的患者实施了急诊科转诊至门诊心脏病预约的分诊系统。分诊实施前队列和分诊实施后队列分别有303例和267例不同患者。我们收集回顾性计费数据以评估急诊科复诊、住院、心脏病门诊就诊及心血管检查情况。分诊实施前队列包括2014年1月1日至2014年12月31日期间急诊科就诊的患者。分诊实施后队列包括2015年7月1日至2016年6月30日期间急诊科就诊的患者。
分诊模式使急诊科转诊的心血管服务预约数量减少了73.0%（267例患者中的195例）。此外，预约的“爽约”率从17.8%（303例患者中的54例）降至7.9%（267例患者中的21例）。分诊后队列中的急诊科复诊或非计划住院情况没有增加。最后，分诊模式与资源密集型心血管检查（如影像负荷试验或计算机断层扫描）的增加无关。
对急诊科转诊至门诊心血管服务预约进行分诊可降低心脏病预约利用率，且对急诊科复诊、住院或心血管检查无影响。
