转诊审查揭示了转诊内容对眼科候诊名单的分诊和管理的影响。
Review of referrals reveal the impact of referral content on the triage and management of ophthalmology wait lists.
机构信息
Centre for Eye Health, Sydney, New South Wales, Australia.
School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
出版信息
BMJ Open. 2021 Sep 7;11(9):e047246. doi: 10.1136/bmjopen-2020-047246.
OBJECTIVES
Many chronic eye conditions are managed within public hospital ophthalmology clinics resulting in encumbered wait lists. Integrated care schemes can increase system capacity. In order to direct implementation of a public hospital-based integrated eye care model, this study aims to evaluate the quality of referrals for new patients through information content, assess triage decisions of newly referred patients and evaluate the consistency of referral content for new patients referred multiple times.
DESIGN
A retrospective and prospective review of all referral forms for new patients referred to a public hospital ophthalmology clinic between January 2016 and September 2017, and September 2017 and August 2018, respectively.
SETTING
A referral-only public hospital ophthalmology clinic in metropolitan Sydney, Australia.
PARTICIPANTS
418 new patients on existing non-urgent wait lists waiting to be allocated an initial appointment, and 528 patients who were newly referred.
PRIMARY AND SECONDARY OUTCOME MEASURES
The primary outcome was the information content of referrals for new patients. The secondary outcomes were triage outcomes for new incoming referrals, and the number of new patients with multiple referrals.
RESULTS
Of the wait-listed referrals, 0.2% were complete in referral content compared with 9.8% of new incoming referrals (p<0.001). Of new incoming referrals, 56.7% were triaged to a non-urgent clinic. Multiple referrals were received for 49 patients, with no change in the amount of referral content.
CONCLUSIONS
Most referrals were incomplete in content, leading to triage based on limited clinical information. Some new patients were referred multiple times with their second referral containing a similar amount of content as their first. Lengthy wait lists could be prevented by improving administrative processes and communication between the referral centre and referrers. The future implementation of an integrated eye care model at the study setting could sustainably cut wait lists for patients with chronic eye conditions.
目的
许多慢性眼病在公立医院眼科诊所得到治疗，导致候诊名单冗长。综合护理计划可以增加系统容量。为了指导公立医院为基础的综合眼科护理模式的实施，本研究旨在通过信息内容评估新患者转诊的质量，评估新转诊患者的分诊决策，并评估多次转诊的新患者转诊内容的一致性。
设计
对 2016 年 1 月至 2017 年 9 月和 2017 年 9 月至 2018 年 8 月期间转诊至公立医院眼科诊所的所有新患者转诊表进行回顾性和前瞻性审查。
地点
澳大利亚大都市悉尼的一家转诊公立医院眼科诊所。
参与者
418 名现有非紧急等候名单上的新患者等待分配首次预约，528 名新转诊患者。
主要和次要结果
主要结果是新患者转诊的信息内容。次要结果是新转诊患者的分诊结果，以及有多份转诊记录的新患者人数。
结果
在等候名单转诊中，转诊内容完整的占 0.2%，而新传入转诊中完整的占 9.8%（p<0.001）。在新传入的转诊中，56.7%被分诊到非紧急诊所。49 名患者收到了多次转诊，转诊内容量没有变化。
结论
大多数转诊的内容不完整，导致根据有限的临床信息进行分诊。一些新患者被多次转诊，第二次转诊的内容与第一次相似。通过改进转诊中心和转诊医生之间的行政流程和沟通，可以避免冗长的候诊名单。在研究环境中实施综合眼科护理模式，可以为慢性眼病患者持续缩短候诊名单。
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