Montalto M, Harris P, Rosengarten P
Department of Public Health and Community Medicine, University of Melbourne.
Aust Fam Physician. 1994 Jul;23(7):1320-1, 1324-5, 1328.
We sought to determine the impact of general practitioner communication on the efficient management of patients who present to the emergency department. Casemix, severity, time of presentation, the quality of the letter and the reception of a telephone call were considered.
All consecutive patients presenting to the emergency department of Mornington Peninsula Hospital (Frankston) for one month in 1992 were included in this survey. The methodology is summarised in Figure 1.
The referral letter made no difference to patients' waiting time and time spent in the department and a non significant difference in communication back to the general practitioner. This was found despite the quality of the referral letter, the time of presentation, and the diagnosis. The general practitioners' telephone call, however, decreased significantly the patient's waiting time. Investigations that were reported in the general practitioners' letters and not repeated by the emergency department resulted in a direct saving of $2604 for the month of the study. High interrater reliability was discovered in the rating of letters by six general practitioners.
Despite the ability of general practitioners to select appropriate cases for referral, only the telephone call results in a quantifiable benefit for patients who attend their general practitioner. The high inter-rater reliability affirms the use of referral letters as audit tools in general practice. Better practical use could be made of general practitioners' referral communication to the emergency department.
我们试图确定全科医生的沟通对前往急诊科就诊患者的有效管理所产生的影响。我们考虑了病例组合、病情严重程度、就诊时间、信件质量以及电话接听情况。
1992年，连续一个月内在莫宁顿半岛医院（弗兰克斯顿）急诊科就诊的所有患者均纳入本次调查。方法总结见图1。
转诊信对患者的等待时间和在科室停留的时间没有影响，且与反馈给全科医生的沟通情况差异不显著。尽管转诊信质量、就诊时间及诊断情况各异，但结果依然如此。然而，全科医生的电话显著缩短了患者的等待时间。在研究当月，全科医生信件中报告且急诊科未重复进行的检查直接节省了2604美元。六位全科医生对信件的评分显示出较高的评分者间信度。
尽管全科医生有能力选择合适的病例进行转诊，但只有电话对前往全科医生处就诊的患者产生了可量化的益处。较高的评分者间信度肯定了转诊信在全科医疗中作为审核工具的用途。全科医生与急诊科之间的转诊沟通可以得到更好的实际应用。
