Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Belfield, Dublin 4, Ireland.
Faculty of Health Sciences, University of Castilla-La Mancha, Avd. Real Fabrica de Sedas s/n. 45600 Talavera de la Reina, Toledo, Spain.
BMC Fam Pract. 2020 Oct 16;21(1):210. doi: 10.1186/s12875-020-01277-9.
Clinical guidelines are integral to a general practitioner's decision to refer a paediatric patient to emergency care. The influence of non-clinical factors must also be considered. This review explores the non-clinical factors that may influence general practitioners (GPs) when deciding whether or not to refer a paediatric patient to the Emergency Department (ED).
A systematic review of peer-reviewed literature published from August 1980 to July 2019 was conducted to explore the non-clinical factors that influence GPs' decision-making in referring paediatric patients to the emergency department. The results were synthesised using a narrative approach.
Seven studies met the inclusion criteria. Non-clinical factors relating to patients, GPs and health systems influence GPs decision to refer children to the ED. GPs reported parents/ caregivers influence, including their perception of severity of child's illness, parent's request for onward referral and GPs' appraisal of parents' ability to cope. Socio-economic status, GPs' aversion to risk and system level factors such as access to diagnostics and specialist services also influenced referral decisions.
A myriad of non-clinical factors influence GP referrals of children to the ED. Further research on the impact of non-clinical factors on clinical decision-making can help to elucidate patterns and trends of paediatric healthcare and identify areas for intervention to utilise resources efficiently and improve healthcare delivery.
临床指南是全科医生决定将儿科患者转至急诊护理的重要依据。还必须考虑非临床因素的影响。本综述探讨了可能影响全科医生（GP）决定是否将儿科患者转至急诊部（ED）的非临床因素。
对 1980 年 8 月至 2019 年 7 月发表的同行评议文献进行系统回顾，以探讨影响 GP 将儿科患者转至急诊部的非临床因素。使用叙述方法综合结果。
符合纳入标准的有 7 项研究。与患者、GP 和卫生系统相关的非临床因素影响 GP 将儿童转至 ED 的决策。GP 报告了父母/照顾者的影响，包括他们对孩子疾病严重程度的看法、父母要求转院以及 GP 对父母应对能力的评估。社会经济地位、GP 对风险的回避以及系统层面的因素，如诊断和专科服务的可及性，也影响了转诊决策。
诸多非临床因素影响 GP 将儿童转至 ED。进一步研究非临床因素对临床决策的影响，可以帮助阐明儿科医疗保健的模式和趋势，并确定干预领域，以有效利用资源和改善医疗服务提供。
