Carolinas Medical Center, Department of Surgery, Charlotte, NC.
Atrium Health, Information and Analytics Services, Charlotte, NC.
Surgery. 2024 Feb;175(2):387-392. doi: 10.1016/j.surg.2023.10.033. Epub 2023 Nov 27.
Freestanding emergency departments have risen in popularity as a means to expand access to care. Although some evaluation of freestanding emergency department utility in specific patient populations exists, management of surgical patients via remote triage and disposition has not been previously described. We report our experience with remote triage to discharge home, level I trauma center, or community hospital admission for general surgery patients who present to an affiliated freestanding emergency department.
A retrospective cohort study of patients presenting to freestanding emergency departments requiring surgical consultation between 2016 and 2021 was conducted. Outcomes included disposition, length of stay, surgical intervention, 30-day mortality, and readmission. Undertriage and overtriage rates were calculated and defined as the following: (1) discharge undertriage-discharge home with 30-day emergency department visit/readmission; 2) transfer undertriage-transfers to community hospital requiring transfer to trauma center; and (3) overtriage-admissions <24 hours without surgery.
Of 1,105 patients, 15% were discharged home, 27% were transferred to trauma centers, and 58% were transferred to community hospitals. Patients admitted to trauma centers were older and had higher acuity pathology, whereas patients admitted to community hospitals had higher operative rates with shorter lengths of stay, operating room time, 30-day readmission, and mortality. Transfer undertriage was 0.9% (n = 6), with only 1 patient requiring transfer from a community hospital to a trauma center for disease acuity. Discharge undertriage was 12% (n = 20) due to worsening or persistent pathology. Overtriage was 5.5% (n = 52), with most having a partial small bowel obstruction or ambiguous diagnostic imaging requiring observation.
Remote surgery triage at freestanding emergency departments, without an in-person examination, demonstrated both low undertriage and overtriage rates, reflecting appropriate triage practices.
独立急诊部作为扩大医疗服务可及性的一种手段，越来越受到欢迎。尽管已经对特定患者群体中独立急诊部的使用进行了一些评估，但远程分诊和处置手术患者的管理尚未得到描述。我们报告了我们对附属独立急诊部就诊的普外科患者进行远程分诊至出院、一级创伤中心或社区医院入院的经验。
对 2016 年至 2021 年期间需要普外科会诊的独立急诊部就诊患者进行了回顾性队列研究。结局包括处置、住院时间、手术干预、30 天死亡率和再入院率。计算并定义了分诊不足和过度分诊的发生率，具体如下：(1)出院分诊不足-出院后 30 天内急诊就诊/再入院；(2)转院分诊不足-转往社区医院，需要转往创伤中心；(3)过度分诊-入院不足 24 小时，无手术。
1105 例患者中，15%出院，27%转往创伤中心，58%转往社区医院。转往创伤中心的患者年龄较大，且病情较重，而转往社区医院的患者手术率较高，住院时间、手术室时间、30 天再入院率和死亡率较短。转院分诊不足的发生率为 0.9%（n=6），仅有 1 例患者因疾病严重程度需要从社区医院转往创伤中心。出院分诊不足的发生率为 12%（n=20），原因是病情恶化或持续存在。过度分诊的发生率为 5.5%（n=52），其中大多数患者有不完全性小肠梗阻或需要观察的不明确诊断影像学表现。
独立急诊部的远程手术分诊，无需进行面对面检查，分诊不足和过度分诊的发生率均较低，反映了适当的分诊实践。
