Bukhman Alice Kidder, Baugh Christopher W, Yun Brian J
Brigham and Women's Faulkner Emergency Department, 1153 Centre Street, Boston, MA 02130, USA; Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Neville House 2nd Floor, Boston, MA 02115, USA.
Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Neville House 2nd Floor, Boston, MA 02115, USA.
Emerg Med Clin North Am. 2020 Aug;38(3):647-661. doi: 10.1016/j.emc.2020.04.004. Epub 2020 Jun 10.
Alternatives to inpatient admission have been shown to be safe and effective for a variety of clinical conditions and can help relieve emergency department (ED) and inpatient crowding. Evidence-based alternatives include use of rapid ED follow-up clinics, observation units, and home hospital programs. Use of accelerated diagnostic pathways and shared decision making can help support clinicians and patients in appropriately choosing an alternative disposition to traditional inpatient admission. However, many institutions struggle to fully embrace possible alternative depositions because of challenges of patient access, clinician and patient comfort with diagnostic uncertainty, and perceived medicolegal risks.
对于多种临床病症，住院治疗的替代方案已被证明是安全有效的，并且有助于缓解急诊科（ED）和住院部的拥挤状况。循证替代方案包括设立急诊快速随访诊所、观察病房和居家医院项目。采用加速诊断路径和共同决策有助于支持临床医生和患者适当选择替代传统住院治疗的处置方式。然而，由于患者就诊机会、临床医生和患者对诊断不确定性的接受度以及感知到的法医学风险等方面存在挑战，许多机构难以全面采用可能的替代处置方式。
