Bernstein Charles N, Crocker Elise, Nugent Zoann, Virdi Paramvir, Singh Harminder, Targownik Laura E
Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
J Can Assoc Gastroenterol. 2020 Feb 17;4(2):57-64. doi: 10.1093/jcag/gwz050. eCollection 2021 Apr.
To describe the patterns of care when persons with inflammatory bowel disease (IBD) present to the Emergency Department (ED) and post-ED follow-up.
We linked the University of Manitoba IBD Epidemiology Database with the Emergency Department Information System of the Winnipeg Regional Health Authority from January 1, 2010 to December 31, 2012. We then generated a list of all ED attendances by persons with IBD at four of six hospitals within the City of Winnipeg (two academic and two community hospitals). The charts were reviewed by two investigators extracting data on testing, consulting and treatment undertaken in the ED as well as postdischarge follow-up. We focused on outcomes among those attending the ED but not admitted to hospital.
Of 1275 IBD patients with a first visit to the ED, 523 (41%) were for IBD-specific complaints. Three hundred and twenty-seven (62.5%) were discharged from the ED without an in-hospital admission. Nearly 80% had an identified gastrointestinal (GI) specialist (either gastroenterologist or GI surgeon) involved in their care. A gastroenterologist was consulted in the ED 20% of the time. Follow-up post-ED with a gastroenterologist was only documented in 36%. For those who saw a gastroenterologist in the ED, there was more likely to be a change in medications and follow-up arranged with a gastroenterologist. ED consultation with a gastroenterologist was the only predictor of seeing a gastroenterologist in follow-up post-ED.
ED gastroenterology consultation is more likely to effect IBD management change. When discharged from the ED gastroenterology, follow-up should be arranged and documented.
描述炎症性肠病（IBD）患者前往急诊科（ED）就诊及急诊科后续随访的护理模式。
我们将曼尼托巴大学IBD流行病学数据库与温尼伯地区卫生局的急诊科信息系统在2010年1月1日至2012年12月31日期间进行了关联。然后，我们生成了温尼伯市内六家医院中四家医院（两家学术医院和两家社区医院）IBD患者的所有急诊科就诊记录清单。两位研究人员对病历进行了审查，提取了在急诊科进行的检查、会诊和治疗以及出院后随访的数据。我们重点关注那些前往急诊科但未住院的患者的结局。
在1275例首次前往急诊科就诊的IBD患者中，523例（41%）是因IBD特异性主诉就诊。327例（62.5%）患者从急诊科出院时未住院。近80%的患者有指定的胃肠病（GI）专科医生（胃肠病学家或胃肠外科医生）参与其护理。在急诊科有20%的时间会咨询胃肠病学家。急诊科后随访胃肠病学家的记录仅为36%。对于那些在急诊科看过胃肠病学家的患者，更有可能发生药物变化并安排与胃肠病学家进行随访。在急诊科咨询胃肠病学家是急诊科后随访中能否见到胃肠病学家的唯一预测因素。
急诊科胃肠病学咨询更有可能影响IBD的管理变化。从急诊科胃肠病科出院时，应安排并记录随访情况。
