Pearson S D, Goldman L, Garcia T B, Cook E F, Lee T H
Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115.
J Gen Intern Med. 1994 May;9(5):241-7. doi: 10.1007/BF02599648.
To determine the response of physicians to a noncoercive prediction rule for the triage of emergency department patients with chest pain.
Prospective time-series intervention study.
A university hospital emergency department.
PARTICIPANTS/PATIENTS: 68 physicians, all of whom were responsible for the triage of at least one of 252 patients presenting to the emergency department with a chief complaint of acute chest pain.
A previously validated algorithmic prediction rule that was attached to the back of patient data forms in the emergency department.
Patients' clinical data were recorded by the examining physician in the emergency department or by a research nurse blinded to patient outcome. The physicians recorded their own estimates of the risk of acute myocardial infarction and their reactions to the prediction rule in a self-administered questionnaire completed at the time of triage.
The physicians reported that they looked at the prediction rule during the triage of 115 (46%) of the 252 patients. The likelihood of using the prediction rule decreased significantly with increasing level of physician training. The most common reasons given for disregarding the prediction rule were confidence in unaided decision making and lack of time. The physicians reported that of the 115 cases for which the prediction rule was used, only one triage decision (1%) was changed by it. Future research should explore how prediction rules can be designed and implemented to surmount the barriers highlighted by these data.
确定医生对用于急诊科胸痛患者分诊的非强制性预测规则的反应。
前瞻性时间序列干预研究。
一家大学医院急诊科。
参与者/患者：68名医生，他们都负责对至少一名因急性胸痛为主诉前来急诊科就诊的252名患者进行分诊。
一种先前经验证的算法预测规则，该规则附在急诊科患者数据表格的背面。
患者的临床数据由急诊科的检查医生或对患者结局不知情的研究护士记录。医生在分诊时通过自行填写的问卷记录他们自己对急性心肌梗死风险的估计以及他们对预测规则的反应。
医生报告称，在对252名患者中的115名（46%）进行分诊时，他们查看了预测规则。随着医生培训水平的提高，使用预测规则的可能性显著降低。不考虑预测规则的最常见原因是对独立决策有信心和缺乏时间。医生报告称，在使用预测规则的115例病例中，只有一项分诊决策（1%）因该规则而改变。未来的研究应探索如何设计和实施预测规则，以克服这些数据所凸显的障碍。
