Centre de recherche Charles-Le Moyne, Département des sciences de la santé communautaire, Université de Sherbrooke, Campus Longueuil, Longueuil, Québec, Canada.
Emergency Department, Sacré-Coeur Hospital, Montreal, Québec, Canada.
BMC Emerg Med. 2024 Sep 13;24(1):166. doi: 10.1186/s12873-024-01080-0.
Overcrowded emergency departments (EDs) are associated with higher morbidity and mortality and suboptimal quality-of-care. Most ED flow management strategies focus on early identification and redirection of low-acuity patients to primary care settings. To assess the impact of redirecting low-acuity ED patients to medical clinics using an electronic clinical decision support system on four ED performance indicators.
We performed a retrospective observational study in the ED of a Canadian tertiary trauma center where a redirection process for low-acuity patients was implemented. The process was based on a clinical decision support system relying on an algorithm based on chief complaint, performed by nurses at triage and not involving physician assessment. All patients visiting the ED from 2013 to 2017 were included. We compared ED performance indicators before and after implementation of the redirection process (June 2015): length-of-triage, time-to-initial-physician-assessment, length-of-stay and rate of patients leaving without being seen. We performed an interrupted time series analysis adjusted for age, gender, time of visit, triage category and overcrowding.
Of 242,972 ED attendees over the study period, 9546 (8% of 121,116 post-intervention patients) were redirected to a nearby primary medical clinic. After the redirection process was implemented, length-of-triage increased by 1 min [1;2], time-to-initial assessment decreased by 13 min [-16;-11], length-of-stay for non-redirected patients increased by 29 min [13;44] (p < 0.001), minus 20 min [-42;1] (p = 0.066) for patients assigned to triage 5 category. The rate of patients leaving without being seen decreased by 2% [-3;-2] (p < 0.001).
Implementing a redirection process for low-acuity ED patients based on a clinical support system was associated with improvements in two of four ED performance indicators.
急诊部门（ED）过度拥挤与更高的发病率和死亡率以及较差的医疗质量有关。大多数 ED 流量管理策略都侧重于早期识别和将低危患者重新引导到初级保健机构。使用电子临床决策支持系统将低危 ED 患者重新引导到医疗诊所，以评估对四个 ED 绩效指标的影响。
我们在加拿大一家三级创伤中心的 ED 进行了一项回顾性观察研究，在该中心实施了低危患者的重新定向流程。该过程基于依赖于主要投诉的算法的临床决策支持系统，由分诊护士执行，不涉及医生评估。2013 年至 2017 年期间所有访问 ED 的患者均包括在内。我们比较了重新定向流程实施前后（2015 年 6 月）的 ED 绩效指标：分诊时间、初始医生评估时间、住院时间和未就诊离开的患者比例。我们进行了调整年龄、性别、就诊时间、分诊类别和拥挤程度的中断时间序列分析。
在研究期间，242972 名 ED 就诊者中，有 9546 名（121116 名干预后患者的 8%）被重新定向到附近的初级医疗诊所。重新定向流程实施后，分诊时间增加了 1 分钟[1；2]，初始评估时间减少了 13 分钟[-16；-11]，非重新定向患者的住院时间增加了 29 分钟[13；44]（p<0.001），分配给分诊 5 类别的患者减少了 20 分钟[-42；1]（p=0.066）。未就诊离开的患者比例下降了 2%[-3；-2]（p<0.001）。
基于临床支持系统为低危 ED 患者实施重新定向流程与四个 ED 绩效指标中的两个指标的改善相关。
