Health Research, Evidence and Impact, McMaster University, Hamilton, New Zealand, Canada
Health Research, Evidence and Impact, McMaster University, Hamilton, New Zealand, Canada.
BMJ Open Qual. 2023 Mar;12(1). doi: 10.1136/bmjoq-2022-002160.
Paramedics redirecting non-emergent patients from emergency departments (EDs) to urgent care centres is a new and forthcoming strategy to reduce overcrowding and improve primary care integration. Which patients are likely not suitable for paramedic redirection are unknown. To describe and specify patients inappropriate for urgent care centres, we examined associations between patient characteristics and transfer to the ED after patients initially presented to an urgent care centre.
A population-based retrospective cohort study of all adult (≥18 years) visits to an urgent care centre from 1 April 2015 to 31 March 2020 in Ontario, Canada. Binary logistic regression was used to determine unadjusted and adjusted associations between patient characteristics and being transferred to an ED using OR and 95% CIs. We calculated the absolute risk difference for the adjusted model.
A total of 1 448 621 urgent care visits were reported, with 63 343 (4.4%) visits transferred to an ED for definitive care. Being 65 years and older (OR 2.29, 95% CI 2.23 to 2.35), scored an emergent Canadian Triage and Acuity Scale of 1 or 2 (OR 14.27, 95% CI 13.45 to 15.12) and higher comorbidity count (OR 1.51, 95% CI 1.46 to 1.58) had added odds of association with being transferred out to an ED.
Readily available patient characteristics were independently associated with interfacility transfers between urgent care centres and the ED. This study can support paramedic redirection protocol development, highlighting which patients may not be best suited for ED redirection.
将非紧急患者从急诊部（ED）转至紧急护理中心是一种新的、即将出现的策略，旨在减少过度拥挤并改善初级保健的整合。目前尚不清楚哪些患者不适合接受护理人员的转介。为了描述和确定不适合紧急护理中心的患者，我们检查了患者最初到紧急护理中心就诊后转至 ED 的特征与患者特征之间的关联。
这是一项在加拿大安大略省于 2015 年 4 月 1 日至 2020 年 3 月 31 日期间进行的所有成人（≥18 岁）至紧急护理中心就诊的基于人群的回顾性队列研究。使用二元逻辑回归确定患者特征与转至 ED 的未调整和调整后关联，采用 OR 和 95%CI 表示。我们计算了调整后模型的绝对风险差异。
共报告了 1 448 621 次紧急护理就诊，其中有 63 343 次（4.4%）就诊因确定性治疗被转至 ED。65 岁及以上（OR 2.29，95%CI 2.23 至 2.35）、加拿大分诊和急症严重程度分级（CTAS）评分为 1 或 2（OR 14.27，95%CI 13.45 至 15.12）和更高的合并症数量（OR 1.51，95%CI 1.46 至 1.58）与转至 ED 的几率增加有关。
现成的患者特征与紧急护理中心和 ED 之间的院内转介独立相关。这项研究可以为护理人员转介协议的制定提供支持，突出哪些患者可能不适合 ED 转介。
