Hôpital du Sacré-Cœur de Montréal, CIUSSS-NIM, 5400 boulevard Gouin Ouest, Montréal, Québec, H4J 1C5, Canada.
CR-CSIS, Sherbrooke University, Longueuil, Québec, Canada.
BMC Emerg Med. 2022 Apr 29;22(1):71. doi: 10.1186/s12873-022-00626-4.
Emergency departments (EDs) are operating at or above capacity, which has negative consequences on patients in terms of quality of care and morbi-mortality. Redirection strategies for low-acuity ED patients to primary care practices are usually based on subjective eligibility criteria that sometimes necessitate formal medical assessment. Literature investigating the effect of those interventions is equivocal. The aim of the present study was to assess the safety of a redirection process using an electronic clinical support system used by the triage nurse without physician assessment.
A single cohort observational study was performed in the ED of a level 1 academic trauma center. All low-acuity patients redirected to nearby clinics through a clinical decision support system (February-August 2017) were included. This system uses different sets of medical prerequisites to identify patients eligible to redirection. Data on safety and patient experience were collected through phone questionnaires on day 2 and 10 after ED visit. The primary endpoint was the rate of redirected patients returning to any ED for an unexpected visit within 48 h. Secondary endpoints were the incidence of 7-day return visit and satisfaction rates.
A total of 980 redirected low-acuity patients were included over the period: 18 patients (2.8%) returned unexpectedly to an ED within 48 h and 31 patients (4.8%) within 7 days. No hospital admission or death were reported within 7 days following the first ED visit. Among redirected patients, 81% were satisfied with care provided by the clinic staff.
The implementation of a specific electronic-guided decision support redirection protocol appeared to provide safe deferral to nearby clinics for redirected low-acuity patients. EDs are pivotal elements of the healthcare system pathway and redirection process could represent an interesting tool to improve the care to low-acuity patients.
急诊科（ED）的运转能力达到或超过了负荷，这对患者的护理质量和病死率/发病率产生了负面影响。将低危 ED 患者重新分配到初级保健诊所的策略通常基于主观的合格标准，有时需要进行正式的医学评估。调查这些干预措施效果的文献结果不一。本研究旨在评估使用分诊护士的电子临床支持系统进行重新分配过程的安全性，而无需医生评估。
在一级学术创伤中心的 ED 中进行了一项单队列观察性研究。所有通过临床决策支持系统（2017 年 2 月至 8 月）重新分配到附近诊所的低危患者均纳入研究。该系统使用不同的医疗先决条件集来识别有资格重新分配的患者。通过 ED 就诊后第 2 天和第 10 天的电话问卷调查收集安全性和患者体验数据。主要终点是重新分配患者在 48 小时内因意外就诊返回任何 ED 的比例。次要终点为 7 天内复诊的发生率和满意度。
在此期间，共有 980 例低危患者被重新分配：18 例（2.8%）在 48 小时内意外返回 ED，31 例（4.8%）在 7 天内返回。在首次 ED 就诊后 7 天内未报告住院或死亡。在重新分配的患者中，81%对诊所工作人员提供的护理表示满意。
实施特定的电子引导决策支持重新分配方案似乎为重新分配的低危患者安全转诊到附近诊所提供了保障。ED 是医疗保健系统路径的关键要素，重新分配过程可能是改善低危患者护理的一种有趣工具。
