Martins Marta, Marques Rita, Sousa Marina, Valério Ana, Cabral Isadora, Almeida Filomena
Serviço de Pediatria. Hospital Garcia de Orta. Almada. Portugal.
Unidade de Saúde Familiar S. João do Pragal. Agrupamentos de Centro de Saúde Almada-Seixal. Almada. Portugal.
Acta Med Port. 2020 May 4;33(5):311-317. doi: 10.20344/amp.12769.
Frequent users contribute to an excessive volume of admissions in the emergency department, impairing the quality of healthcare services. The aim of this study was to identify and characterize the population of frequent users of the pediatric emergency department, establish an individual plan of intervention and evaluate its efficacy.
Intervention study including children and adolescents younger than 16 years, with more than 10 visits in a year to an emergency department of a secondary care hospital. An intervention program was created with a multidisciplinary team and a case manager, who was responsible for the execution of the individual plan of intervention. One year later, the number of visits after the intervention was assessed.
We identified 90 patients with a frequent user profile, with 1182 visits. Only 17.3% of the visits had a previous referral. Most of the visits were considered non urgent/less urgent (59%). The intervention included 82 children/adolescents. One year later, there was a significant reduction in the number of visits: median reduction of 62% in 78 participants.
Most of the visits by frequent users were considered non urgent/less urgent, reflecting a clinically unjustified use of the emergency department. The intervention seems to be effective as the number of visits decreased.
This population of frequent users seems to be a heterogeneous group with different problems and levels of complexity. A multidisciplinary and individual intervention, with a case manager, might contribute to reduce the excessive use of the emergency department and improve the provision of health care services to these children.
频繁就诊者导致急诊科就诊量过多，影响了医疗服务质量。本研究的目的是识别和描述儿科急诊科频繁就诊人群的特征，制定个性化干预计划并评估其效果。
干预性研究，纳入16岁以下儿童和青少年，他们一年内在一家二级护理医院的急诊科就诊超过10次。由多学科团队和一名个案管理员制定了一项干预计划，个案管理员负责执行个性化干预计划。一年后，评估干预后的就诊次数。
我们识别出90例符合频繁就诊特征的患者，共就诊1182次。只有17.3%的就诊有之前的转诊记录。大多数就诊被认为是非紧急/低紧急程度（59%）。干预对象包括82名儿童/青少年。一年后，就诊次数显著减少：78名参与者的就诊次数中位数减少了62%。
频繁就诊者的大多数就诊被认为是非紧急/低紧急程度，这反映出急诊科存在临床不合理使用的情况。随着就诊次数减少，干预似乎是有效的。
这群频繁就诊者似乎是一个异质性群体，存在不同问题且复杂程度各异。由个案管理员进行的多学科个性化干预可能有助于减少急诊科的过度使用，并改善为这些儿童提供的医疗服务。
