Murphy A W, Bury G, Plunkett P K, Gibney D, Smith M, Mullan E, Johnson Z
Department of General Practice, University College Dublin, Coombe Healthcare Centre, Ireland.
BMJ. 1996 May 4;312(7039):1135-42. doi: 10.1136/bmj.312.7039.1135.
To see whether care provided by general practitioners to non-emergency patients in an accident and emergency department differs significantly from care by usual accident and emergency staff in terms of process, outcome, and comparative cost.
A randomised controlled trial.
A busy inner city hospital's accident and emergency department which employed three local general practitioners on a sessional basis.
All new attenders categorised by the triage system as "semiurgent" or "delay acceptable." 66% of all attenders were eligible for inclusion.
Numbers of patients undergoing investigation, referral, or prescription; types of disposal; consultation satisfaction scores; reattendance to accident and emergency department within 30 days of index visit; health status at one month; comparative cost differences.
4684 patients participated. For semiurgent patients, by comparison with usual accident and emergency staff, general practitioners investigated fewer patients (relative difference 20%; 95% confidence interval 16% to 25%), referred to other hospital services less often (39%; 28% to 47%), admitted fewer patients (45%; 32% to 56%), and prescribed more often (41%; 30% to 54%). A similar trend was found for patients categorised as delay acceptable and (in a separate analysis) by presenting complaint category. 393 (17%) patients who had been seen by general practitioner staff reattended the department within 30 days of the index visit; 418 patients (18%) seen by accident and emergency staff similarly reattended, 435 patients (72% of those eligible) completed the consultation satisfaction questionnaire and 258 (59% of those eligible) provided health status information one month after consultation. There were no differences between patients managed by general practitioners and those managed by usual staff regarding consultation satisfaction questionnaire scores or health status. For all patients seen by general practitioners during the study, estimated marginal and total savings were Ir1427 pounds and Ir117,005 pounds respectively.
General practitioners working as an integral part of an accident and emergency department manage non-emergency accident and emergency attenders safely and use fewer resources than do usual accident and emergency staff.
探讨在事故与急救部门，全科医生为非急诊患者提供的护理在过程、结果及成本比较方面是否与事故与急救部门的常规工作人员存在显著差异。
随机对照试验。
一家繁忙的市中心医院的事故与急救部门，该部门定期雇佣三名当地全科医生。
所有经分诊系统归类为“半紧急”或“可延迟”的新就诊者。所有就诊者中有66%符合纳入标准。
接受检查、转诊或开处方的患者数量；处置类型；咨询满意度评分；在首次就诊后30天内再次到事故与急救部门就诊的情况；一个月时的健康状况；成本差异比较。
4684名患者参与研究。与事故与急救部门的常规工作人员相比，对于半紧急患者，全科医生检查的患者较少（相对差异20%；95%置信区间16%至25%），转诊至其他医院服务的情况较少（39%；28%至47%），收治的患者较少（45%；32%至56%），但开处方的情况较多（41%；30%至54%）。对于归类为可延迟的患者以及（在单独分析中）按就诊主诉类别划分的患者，也发现了类似趋势。在首次就诊后30天内，全科医生诊治的患者中有393名（17%）再次到该部门就诊；事故与急救部门工作人员诊治的患者中有418名（18%）同样再次就诊，435名患者（符合条件者的72%）完成了咨询满意度问卷，258名患者（符合条件者的59%）在咨询后一个月提供了健康状况信息。在咨询满意度问卷评分或健康状况方面，全科医生管理的患者与常规工作人员管理的患者之间没有差异。对于研究期间全科医生诊治的所有患者，估计边际节省和总节省分别为1427爱尔兰镑和117,005爱尔兰镑。
作为事故与急救部门不可或缺的一部分工作的全科医生，能够安全地管理非急诊事故与急救就诊者，且比事故与急救部门的常规工作人员使用的资源更少。
