在急诊环境中使用症状评估应用程序对就诊患者进行分诊自我评估的安全性：观察性前瞻性横断面研究。
Safety of Triage Self-assessment Using a Symptom Assessment App for Walk-in Patients in the Emergency Care Setting: Observational Prospective Cross-sectional Study.
机构信息
Charité Universitäsmedizin Berlin, Berlin, Germany.
Department of Emergency Medicine, University Clinic Marburg, Philipps-University, Marburg, Germany.
出版信息
JMIR Mhealth Uhealth. 2022 Mar 28;10(3):e32340. doi: 10.2196/32340.
BACKGROUND
Increasing use of emergency departments (EDs) by patients with low urgency, combined with limited availability of medical staff, results in extended waiting times and delayed care. Technological approaches could possibly increase efficiency by providing urgency advice and symptom assessments.
OBJECTIVE
The purpose of this study is to evaluate the safety of urgency advice provided by a symptom assessment app, Ada, in an ED.
METHODS
The study was conducted at the interdisciplinary ED of Marburg University Hospital, with data collection performed between August 2019 and March 2020. This study had a single-center cross-sectional prospective observational design and included 378 patients. The app's urgency recommendation was compared with an established triage concept (Manchester Triage System [MTS]), including patients from the lower 3 MTS categories only. For all patients who were undertriaged, an expert physician panel assessed the case to detect potential avoidable hazardous situations (AHSs).
RESULTS
Of 378 participants, 344 (91%) were triaged the same or more conservatively and 34 (8.9%) were undertriaged by the app. Of the 378 patients, 14 (3.7%) had received safe advice determined by the expert panel and 20 (5.3%) were considered to be potential AHS. Therefore, the assessment could be considered safe in 94.7% (358/378) of the patients when compared with the MTS assessment. From the 3 lowest MTS categories, 43.4% (164/378) of patients were not considered as emergency cases by the app, but could have been safely treated by a general practitioner or would not have required a physician consultation at all.
CONCLUSIONS
The app provided urgency advice after patient self-triage that has a high rate of safety, a rate of undertriage, and a rate of triage with potential to be an AHS, equivalent to telephone triage by health care professionals while still being more conservative than direct ED triage. A large proportion of patients in the ED were not considered as emergency cases, which could possibly relieve ED burden if used at home. Further research should be conducted in the at-home setting to evaluate this hypothesis.
TRIAL REGISTRATION
German Clinical Trial Registration DRKS00024909; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00024909.
背景
由于低紧急程度的患者对急诊科（ED）的使用不断增加，加上医务人员数量有限，导致等待时间延长和治疗延迟。技术方法通过提供紧急程度建议和症状评估，可能会提高效率。
目的
本研究旨在评估 Ada 症状评估应用程序提供的紧急程度建议在 ED 中的安全性。
方法
该研究在马尔堡大学医院的跨学科 ED 进行，数据收集于 2019 年 8 月至 2020 年 3 月之间进行。该研究采用单中心横断面前瞻性观察设计，共纳入 378 名患者。该应用程序的紧急建议与既定分诊概念（曼彻斯特分诊系统[MTS]）进行了比较，仅包括下 3 个 MTS 类别中的患者。对于所有分诊不足的患者，专家医生小组评估病例以检测潜在的可避免危险情况（AHS）。
结果
在 378 名参与者中，344 名（91%）被分诊为相同或更保守的类别，34 名（8.9%）被应用程序分诊不足。在 378 名患者中，有 14 名（3.7%）被专家小组确定为安全建议，20 名（5.3%）被认为是潜在的 AHS。因此，与 MTS 评估相比，当与 MTS 评估相比时，该评估在 94.7%（358/378）的患者中可被认为是安全的。在 3 个最低 MTS 类别中，43.4%（164/378）的患者未被应用程序视为紧急情况，但可以由全科医生安全治疗，或者根本不需要医生就诊。
结论
该应用程序在患者自我分诊后提供紧急程度建议，具有高安全性、分诊不足率和可能成为 AHS 的分诊率，与医疗保健专业人员的电话分诊相当，同时仍然比直接 ED 分诊更保守。ED 中有相当一部分患者不被视为紧急情况，如果在家中使用，可能会减轻 ED 的负担。应在家庭环境中进行进一步的研究来评估这一假设。
试验注册
德国临床试验注册 DRKS00024909；https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024909。
Zotero 插件