Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA.
Atrium Health, Information and Analytics Services, 720 East Morehead St, Charlotte, NC, 28203, USA.
Surg Endosc. 2023 Oct;37(10):7901-7907. doi: 10.1007/s00464-023-10241-4. Epub 2023 Jul 7.
Freestanding emergency departments (FSEDs) have generated improved hospital metrics, including decreased ED wait times and increased patient selection. Patient outcomes and process safety have not been evaluated. This study investigates the safety of FSED virtual triage in the emergency general surgery (EGS) patient population.
A retrospective review evaluated all adult EGS patients admitted to a community hospital between January 2016 and December 2021 who either presented at a FSED and received virtual evaluation from a surgical team (fEGS) or presented at the community hospital emergency department and received in-person evaluation from the same surgical group (cEGS). Patients' demographics, acute care utilization history, and clinical characteristics at the onset of the index visit were used to build a propensity score model and stabilized Inverse Probability of Treatment Weights (IPTW) were used to create a weighted sample. Multivariable regression models were then employed to the weighted sample to evaluate the treatment effect of virtual triage compared to in-person evaluation on short-term outcomes, including length of stay (LOS) and 30-day readmission and mortality. Variables which occurred during the index visit (such as surgery duration and type of surgery) were adjusted for in the multivariable analyses.
Of 1962 patients, 631 (32.2%) were initially evaluated virtually (fEGS) and 1331 (67.8%) underwent an in-person evaluation (cEGS). Baseline characteristics demonstrated significant differences between the cohorts in gender, race, payer status, BMI, and CCI score. Baseline risks were well balanced in the IPTW-weighted sample (SD range 0.002-0.18). Multivariable analysis found no significant differences between the balanced cohorts in 30-day readmission, 30-day mortality, and LOS (p > 0.05 for all).
Patients who undergo virtual triage have similar outcomes to those who undergo in-person triage for EGS diagnoses. Virtual triage at FSED for these EGS patients may be an efficient and safe means for initial evaluation.
独立急诊部 (FSED) 提高了医院的各项指标，包括减少急诊等待时间和增加患者选择。但尚未评估患者的预后和流程安全性。本研究调查了 FSED 虚拟分诊在急诊普通外科 (EGS) 患者中的安全性。
回顾性分析了 2016 年 1 月至 2021 年 12 月期间在一家社区医院就诊的所有成年 EGS 患者，这些患者要么在 FSED 就诊并接受外科团队的虚拟评估 (fEGS)，要么在社区医院急诊就诊并接受同一外科小组的亲自评估 (cEGS)。患者的人口统计学、急性护理使用情况和就诊时的临床特征用于构建倾向评分模型，并使用稳定的逆概率治疗权重 (IPTW) 创建加权样本。然后，多变量回归模型用于加权样本，以评估虚拟分诊与亲自评估对短期结果的治疗效果，包括住院时间 (LOS)、30 天再入院率和死亡率。多变量分析中调整了就诊期间发生的变量（如手术持续时间和手术类型）。
在 1962 名患者中，631 名（32.2%）最初接受了虚拟评估（fEGS），1331 名（67.8%）接受了亲自评估（cEGS）。两组患者的基线特征在性别、种族、付款人身份、BMI 和 CCI 评分方面存在显著差异。在 IPTW 加权样本中，基线风险得到了很好的平衡（SD 范围 0.002-0.18）。多变量分析发现，平衡队列在 30 天再入院率、30 天死亡率和 LOS 方面没有显著差异（p>0.05）。
接受虚拟分诊的患者与接受亲自分诊的 EGS 患者的预后相似。对于这些 EGS 患者，FSED 的虚拟分诊可能是一种有效的、安全的初步评估方法。
