O'Brien G M, Shapiro M J, Fagan M J, Woolard R W, O'Sullivan P S, Stein M D
Department of Medicine, Rhode Island Hospital, Brown University School of Medicine, Providence 02903, USA.
J Gen Intern Med. 1997 Mar;12(3):188-91. doi: 10.1007/s11606-006-5028-2.
The purpose of this study was to determine the levels of agreement between three methods of assessing appropriateness of emergency department (ED) visits. In particular, we tested the agreement between internists and emergency physicians reviewing the ED nurses' triage notes, containing information that might be available by telephone to an internist. For 892 adult patient ED visits reviewed, we found only moderate agreement (kappa = 0.47) between these groups. In cases of disagreement, emergency physicians were 10.3 times more likely than internists to classify those with minor discharge diagnoses as appropriate for ED care. As managed care grows, the determination of ED appropriateness may depend on open discussions between physician groups, as well as on access to timely care in office settings.
本研究的目的是确定三种评估急诊科（ED）就诊适宜性方法之间的一致程度。具体而言，我们测试了内科医生和急诊科医生在审查急诊护士的分诊记录时的一致性，这些记录包含内科医生通过电话可能获取的信息。对于892例接受审查的成年患者的急诊就诊情况，我们发现这些群体之间只有中等程度的一致性（kappa = 0.47）。在存在分歧的情况下，急诊科医生将出院诊断为轻症的患者归类为适合急诊护理的可能性是内科医生的10.3倍。随着管理式医疗的发展，急诊适宜性的判定可能取决于医生群体之间的公开讨论，以及在门诊环境中获得及时护理的机会。
