Ghaleb Ward Ebrahim Abdullah, Almemari Ayesha, Qayyum Hasan
Emergency Medicine, Mafraq Hospital, Abu Dhabi, UAE.
Emergency Medicine and Critical Care, Mafraq Hospital, Abu Dhabi, UAE.
Oman Med J. 2020 Mar 8;35(2):e104. doi: 10.5001/omj.2020.22. eCollection 2020 Mar.
We sought to evaluate the performance provided at a 'See and Treat' (ST) clinic at a tertiary hospital emergency department (ED) in Abu Dhabi, UAE, and to assess its impact on ED crowding.
We conducted a retrospective electronic medical chart review and database analyses. We included patients triaged as triage level 4 (T4) and triage level 5 (T5) as per the Emergency Severity Index treated at ED in the ST clinic and other ED areas, including the off-site Urgent Care Centre (UCC) between 1 June 2016 and 30 June 2017. We analyzed a group of process and outcome measures at our ST clinic and compared them to the same measures in other areas of our ED and the co-located UCC. The process measure analyzed was the door-to-doctor time. In addition, the outcome measures analyzed were the door-to-door time, unplanned return within 72 hours, and feedback from T4 and T5 triaged patients treated at the clinic.
The number of patients enrolled in the study was 43 109. Of these, 11 329 (26.3%) patients were treated at the ST clinic, 6328 (14.7%) were treated at the UCC, and 25 452 (59.0%) were treated at the main ED. The door-to-doctor time was within 30 minutes for 89.0% of ST clinic patients, and 94.0% of patients experienced a door-to-door time of within two hours; 2.1% of these patients returned within 72 hours. Among these, 78.7% returned for an issue related to their first visit. However, none of the patients were admitted on their return visit. For patients presenting to UCC and other parts of our ED, we recorded a door-to-doctor time of within 30 minutes for 80.5% of patients and a door-to-door time of within two hours for 73.0% of patients. We found the difference in waiting times (i.e., door-to-doctor times between ST clinic patients and the rest of ED) to be statistically significant ( < 0.001, 95% confidence interval (CI): 0.56-0.63). However, on comparing door-to-door times, we found the difference between ST clinic patients and the rest of ED patients was not statistically significant.
Door-to-doctor times were shorter in ST clinics compared to other parts of our ED, but there was no statistically significant difference in door-to-door times when comparing ST clinics to the rest of the ED. ST clinic patients had a lower rate of unplanned return within 72 hours, of which, none required admission on the return attendance. We believe ST clinics have a positive impact on reducing ED crowding but acknowledge they are one of the many plausible solutions attributing to optimized patient flow in the ED.
我们试图评估阿联酋阿布扎比一家三级医院急诊科（ED）的“即看即治”（ST）诊所所提供的服务，并评估其对急诊科拥挤情况的影响。
我们进行了回顾性电子病历审查和数据库分析。纳入了2016年6月1日至2017年6月30日期间在ST诊所和急诊科其他区域（包括场外紧急护理中心（UCC））按照急诊严重程度指数分诊为4级（T4）和5级（T5）的患者。我们分析了ST诊所的一组过程和结果指标，并将其与急诊科其他区域和同地的UCC的相同指标进行比较。分析的过程指标是门到医生时间。此外，分析的结果指标是门到门时间、72小时内非计划复诊以及在诊所接受治疗的T4和T5分诊患者的反馈。
纳入研究的患者有43109例。其中，11329例（26.3%）在ST诊所接受治疗，6328例（14.7%）在UCC接受治疗，25452例（59.0%）在主急诊科接受治疗。ST诊所89.0%的患者门到医生时间在30分钟内，94.0%的患者门到门时间在两小时内；这些患者中有2.1%在72小时内复诊。其中，78.7%的患者因首次就诊相关问题复诊。然而，复诊患者均未被收治。对于在UCC和急诊科其他区域就诊的患者，我们记录到80.5%的患者门到医生时间在30分钟内，73.0%的患者门到门时间在两小时内。我们发现等待时间（即ST诊所患者与急诊科其他患者的门到医生时间）的差异具有统计学意义（<0.001，95%置信区间（CI）：0.56 - 0.63）。然而，在比较门到门时间时，我们发现ST诊所患者与急诊科其他患者之间的差异无统计学意义。
与急诊科其他区域相比，ST诊所的门到医生时间更短，但将ST诊所与急诊科其他区域比较时，门到门时间无统计学显著差异。ST诊所患者72小时内非计划复诊率较低，其中复诊时均无需收治。我们认为ST诊所对缓解急诊科拥挤有积极影响，但也承认它们是优化急诊科患者流程的众多可行解决方案之一。
