Prendergast Conor, Ryan John, Barry Louise A, Galvin Rose, Cummins Niamh M
Emergency Department, St Vincents University Hospital, Dublin, Ireland.
Department of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.
Ir J Med Sci. 2025 May 2. doi: 10.1007/s11845-025-03961-0.
Non-urgent care attendances to the emergency department (ED) increase the strain on this sector. Identification of patients who may benefit from appropriate alternative care pathways may serve to lessen ED crowding. However, healthcare professionals from different specialties may differ in their opinion of what is an appropriate use of ED services.
The study aims to establish the consensus between healthcare professionals, from different specialties, on the appropriateness of attendances to an Irish ED.
This was a single centre, cross-sectional study. Data were compiled in anonymised patient summary files (n = 77) from adults attending the ED over 24 h period. These summary files were reviewed by five different healthcare professionals; an emergency medicine consultant (EMC), an emergency medicine specialist registrar (EM SpR), an ED clinical nurse manager (CMN), an advanced paramedic (AP) and a general practitioner (GP). The clinicians were asked if the patient could have been managed by GP the same day or next day, if the patient's ED visit was an inappropriate use of ED resources and to rank on a scale of 0-10 how appropriate the ED visit was.
Inter-rater agreement on management by GP in 24-48 h was 56% and ranged from 30% (CMN) to 40% (EMC). For inappropriate use of ED resources, consensus was 58% and ranged from 12% (GP) to 35% (EMC). Median "appropriateness" rating ranged from 6 (EM SpR) to 8 (AP and CMN). When the "appropriateness" scale was trichotomized, the "inappropriate" attendances ranged from 1% (CMN) to 21% (EM SpR), whilst "appropriate" attendances ranged from 47% (EM SpR) to CMN (78%).
Despite agreement that there was "inappropriate" use of ED services, healthcare professionals from different backgrounds did not reach a general consensus on which attendances were inappropriate. Therefore, expectations regarding patients' ability to self-assess illness or injury severity related to ED attendances may not be reasonable.
非紧急情况前往急诊科（ED）就诊增加了该科室的压力。识别那些可能从适当的替代护理途径中受益的患者，可能有助于减轻急诊科的拥挤状况。然而，不同专业的医疗保健专业人员对于急诊科服务的适当使用的看法可能存在差异。
本研究旨在确定不同专业的医疗保健专业人员之间就爱尔兰急诊科就诊的适当性达成的共识。
这是一项单中心横断面研究。数据汇编在24小时内就诊于急诊科的成人匿名患者摘要文件（n = 77）中。这些摘要文件由五名不同的医疗保健专业人员进行审查；一名急诊医学顾问（EMC）、一名急诊医学专科住院医师（EM SpR）、一名急诊科临床护士经理（CMN）、一名高级护理人员（AP）和一名全科医生（GP）。临床医生被问及患者是否可以在当天或第二天由全科医生处理，患者前往急诊科就诊是否不适当使用了急诊科资源，并在0至10的量表上对急诊科就诊的适当程度进行排名。
关于在24至48小时内由全科医生处理的评分者间一致性为56%，范围从30%（CMN）到40%（EMC）。对于不适当使用急诊科资源，共识为58%，范围从12%（GP）到35%（EMC）。“适当性”评分中位数范围从6（EM SpR）到8（AP和CMN）。当将“适当性”量表分为三类时，“不适当”就诊范围从1%（CMN）到21%（EM SpR），而“适当”就诊范围从47%（EM SpR）到CMN（78%）。
尽管一致认为存在对急诊科服务的“不适当”使用，但不同背景的医疗保健专业人员对于哪些就诊是不适当的并未达成普遍共识。因此，关于患者自我评估与急诊科就诊相关的疾病或损伤严重程度能力的期望可能不合理。
