Afilalo M, Guttman A, Colacone A, Dankoff J, Tselios C, Beaudet M, Lloyd J
Emergency Department, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
J Emerg Med. 1995 Mar-Apr;13(2):259-64. doi: 10.1016/0736-4679(94)00157-x.
We conducted a 14-day survey of the emergency department (ED) at a university tertiary care teaching hospital to examine appropriate and inappropriate use of the ED. The results are based on a convenience sample of 849 patients, selected to represent a 1-week period. Three categories (CAT) of patients were defined. CAT I: patients had a medical condition that could only be assessed in the ED. CAT II: patients had a medical condition that required evaluation either in the ED or elsewhere within 6 hours of triage. CAT III: patients could wait to be evaluated 6 or more hours from time of triage. Patients in CAT II were matched with outpatient facilities (OPF), based on the time of presentation, the presenting complaint, investigative tests, and treatments required. Overall, it was found that 69% of the patients were appropriate users and could have been seen only in the ED. Fifteen percent of the patients were classified as inappropriate users and should have been seen at an OPF. The remaining 15.8% represented "gray zone" cases. An interview conducted on a subset of ambulatory patients revealed the main reasons for choosing to visit the ED were lack of awareness of other facilities, perceived seriousness of condition, trust in the ED staff, or proximity of the ED. It was concluded that misusers represent a small portion of our ED caseload.
我们对一家大学三级护理教学医院的急诊科进行了为期14天的调查，以检查急诊科的合理和不合理使用情况。结果基于849名患者的便利样本，这些患者被选来代表一周的时间段。定义了三类（CAT）患者。CAT I：患者患有只能在急诊科评估的疾病。CAT II：患者患有在分诊后6小时内需要在急诊科或其他地方进行评估的疾病。CAT III：患者可以在分诊后6小时或更长时间后等待评估。根据就诊时间、主诉、检查和所需治疗，将CAT II中的患者与门诊设施（OPF）进行匹配。总体而言，发现69%的患者使用合理，本应仅在急诊科就诊。15%的患者被归类为不合理使用者，本应在门诊设施就诊。其余15.8%为“灰色地带”病例。对一部分门诊患者进行的访谈显示，选择前往急诊科的主要原因是对其他设施缺乏了解、认为病情严重、信任急诊科工作人员或急诊科距离较近。得出的结论是，误用者在我们急诊科的病例量中占一小部分。
