Schleef Tanja, Engeleit Kristine, Krause Olaf, Schneider Nils
Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
Zentrum für Medizin im Alter, DIAKOVERE Henriettenstift, Hannover, Deutschland.
Med Klin Intensivmed Notfmed. 2023 Jun;118(5):382-388. doi: 10.1007/s00063-022-00950-4. Epub 2022 Sep 7.
In a university emergency department (ED), patients with low treatment urgency and general medical complaints are assigned to general practitioners within the ED. The Emergency Severity Index (ESI) was implemented to determine the urgency of treatment.
To investigate the impact of the ESI implementation on the patient population treated by general practitioners and to show the distribution of ESI categories among these patients.
Comparison of emergency patients treated by general practitioners over 6 months before (t0) and after (t1) ESI implementation using routine data and an evaluation form to be completed by the general practitioner. The analysis was carried out descriptively and using the Χ test and t‑test.
At t0, 615 treatment cases and at t1 751 cases were analyzed. There were no significant differences in age, gender, the proportion of patients being referred to ED, or hospital admissions. The ESI classification was predominantly in the low urgency categories ESI 5 (37%) and ESI 4 (46%), with 8% of patients in ESI 3 or 2. The predicted resource needs matched for 76% of patients in ESI 5, for 36% in ESI 4, and for 44% of patients in ESI 3. Hospital admission was required for 3% of ESI 5 patients and 7% of ESI 4 patients.
Even for patients with low treatment urgency, hospital admission may be indicated. In addition, differences from the predicted resource requirements indicate triaging problems in the patient population studied. Thus, the ESI assessment does not seem suitable to redirect patients to non-ED-based outpatient care.
在一所大学的急诊科，治疗紧迫性较低且有一般医疗主诉的患者被分配给急诊科内的全科医生。实施了急诊严重程度指数（ESI）以确定治疗的紧迫性。
调查实施ESI对全科医生治疗的患者群体的影响，并展示这些患者中ESI类别分布情况。
使用常规数据以及由全科医生填写的评估表，比较在实施ESI之前（t0）和之后（t1）6个月内由全科医生治疗的急诊患者。分析采用描述性方法，并使用卡方检验和t检验。
在t0时分析了615例治疗病例，在t1时分析了751例病例。在年龄、性别、转诊至急诊科的患者比例或住院情况方面无显著差异。ESI分类主要为低紧迫性类别ESI 5（37%）和ESI 4（46%），8%的患者为ESI 3或2。ESI 5中76%的患者、ESI 4中36%的患者以及ESI 3中44%的患者的预测资源需求匹配。ESI 5患者中有3%、ESI 4患者中有7%需要住院治疗。
即使对于治疗紧迫性较低的患者，也可能需要住院治疗。此外，与预测资源需求的差异表明在所研究的患者群体中存在分诊问题。因此，ESI评估似乎不适用于将患者转向非急诊科的门诊护理。
