Tierie Elise L, Barten Dennis G, Esteve Cuevas Laura M, Veugelers Rebekka, Gaakeer Menno I
Department of Emergency Medicine, Albert Schweitzer Hospital, 3318 AT Dordrecht, The Netherlands.
Department of Emergency Medicine, Admiraal de Ruyter Hospital, 4462 RA Goes, The Netherlands.
Healthcare (Basel). 2023 Mar 3;11(5):748. doi: 10.3390/healthcare11050748.
Structural insights in the use of protocols and the extent of practice variation in EDs are lacking. The objective is to determine the extent of practice variation in EDs in The Netherlands, based on specified common practices. We performed a comparative study on Dutch EDs that employed emergency physicians to determine practice variation. Data on practices were collected via a questionnaire. Fifty-two EDs across The Netherlands were included. Thrombosis prophylaxis was prescribed for below-knee plaster immobilization in 27% of EDs. Vitamin C was prescribed in 50% of EDs after a wrist fracture. Splitting of applied casts to the upper or lower limb was performed in one-third of the EDs. Analysis of the cervical spine after trauma was performed by the NEXUS criteria (69%), the Canadian C-spine Rule (17%) or otherwise. The imaging modality for cervical spine trauma in adults was a CT scan (98%). The cast used for scaphoid fractures was divided between the short arm cast (46%) and the navicular cast (54%). Locoregional anaesthesia for femoral fractures was applied in 54% of the EDs. EDs in The Netherlands showed considerable practice variation in treatments among the subjects studied. Further research is warranted to gain a full understanding of the variation in practice in EDs and the potential to improve quality and efficiency.
目前缺乏关于急诊室（ED）中方案使用情况及实践差异程度的结构性见解。目的是基于特定的常见做法，确定荷兰急诊室的实践差异程度。我们对荷兰聘用急诊医生的急诊室进行了一项比较研究，以确定实践差异。通过问卷调查收集实践数据。纳入了荷兰各地的52个急诊室。27%的急诊室会为膝下石膏固定开具血栓预防药物。50%的急诊室在手腕骨折后会开具维生素C。三分之一的急诊室会对上肢或下肢已应用的石膏进行切开。创伤后颈椎分析采用NEXUS标准的急诊室占69%，采用加拿大颈椎规则的占17%，其他方式的占17%。成人颈椎创伤的影像学检查方式为CT扫描的占98%。舟骨骨折所用的石膏中，短臂石膏占46%，舟状骨石膏占54%。54%的急诊室会对股骨骨折采用局部麻醉。在所研究的项目中，荷兰的急诊室在治疗方面存在相当大的实践差异。有必要进行进一步研究，以全面了解急诊室实践中的差异以及提高质量和效率的潜力。
