电子门诊肝移植转诊系统提高了适宜性，并允许首次就诊分诊。

Electronic Outpatient Referral System for Liver Transplant Improves Appropriateness and Allows First Visit Triage.

机构信息

Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.

Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome, Italy.

出版信息

Clin Gastroenterol Hepatol. 2022 Jun;20(6):e1388-e1415. doi: 10.1016/j.cgh.2021.10.005. Epub 2021 Oct 11.

DOI:10.1016/j.cgh.2021.10.005

PMID:34648952

Abstract

BACKGROUND & AIMS: Missed or inappropriate referrals of potential candidates for liver transplantation (LT) are common and traditional referral methods (tRs) do not allow for efficient triage. We investigated the effects of a website developed for electronic outpatient referral to LT (eRW-LT) on these issues.

METHODS

We prospectively collected data on all consecutive outpatient referrals to 2 Italian LT centers from January 2015 to December 2019. In the second half of the study, starting from July 2017, referring physicians had the option of using eRW-LT, quickly obtaining the judgment on the appropriateness and urgency of the visit from a transplant hepatologist.

RESULTS

In the second half of the study, there were 99 eRW-LTs and 96 traditional referrals (new tRs), representing a 17.4% increase over the 161 traditional referrals (old tRs) of the first half. With eRW-LT, 11.1% of referrals were judged inappropriate online without booking a visit. Appropriateness, judged at the time of the first visit, was 59.6%, 56.2%, and 94.3% with old tRs, new tRs, and eRW-LT, respectively. Considering the appropriate visits, the median waiting time in days between referral date and first visit appointment was significantly shorter for urgent visits referred with eRW-LT (5.0; 95% CI, 4.8-9.3) compared with nonurgent visits sent with the same system (17.0; 95% CI, 11.5-25.0; P < .0001), those referred with old tRs (14.0; 95% CI, 8.0-23.0; P < .001) and with new tRs (16.0; 95% CI, 10.0-23.0; P < .001).

CONCLUSIONS

eRW-LT allows an increase in the number of referrals for LT, ensuring effective triage and better appropriateness of visits.

摘要

背景与目的

潜在肝移植（LT）候选者的转诊遗漏或不恰当是常见的，传统的转诊方法（tRs）无法进行有效的分诊。我们研究了为 LT 开发的电子门诊转诊网站（eRW-LT）对这些问题的影响。

方法

我们前瞻性地收集了 2015 年 1 月至 2019 年 12 月期间 2 个意大利 LT 中心所有连续门诊转诊的资料。在研究的后半部分，从 2017 年 7 月开始，转诊医生可以选择使用 eRW-LT，从移植肝专家那里快速获得就诊的适当性和紧迫性判断。

结果

在研究的后半部分，有 99 例 eRW-LT 和 96 例传统转诊（新 tRs），与前半部分的 161 例传统转诊（旧 tRs）相比，增加了 17.4%。通过 eRW-LT，有 11.1%的转诊在线被判断为不适当，无需预约就诊。在第一次就诊时判断的适当性，旧 tRs、新 tRs 和 eRW-LT 分别为 59.6%、56.2%和 94.3%。考虑到适当的就诊，通过 eRW-LT 转诊的紧急就诊与同一系统转诊的非紧急就诊相比，转诊日期与首次就诊预约日期之间的中位等待时间（天）显著缩短（5.0；95%CI，4.8-9.3），与旧 tRs（14.0；95%CI，8.0-23.0；P<0.0001）和新 tRs（16.0；95%CI，10.0-23.0；P<0.001）相比。