Payne S R, Brough R J, Mellor D E
Department of Urological Surgery, Manchester Royal Infirmary.
Ann R Coll Surg Engl. 1997 Mar;79(2):111-4.
The effects of new outpatient referrals on the dynamics of global provision in a surgical service has not previously been defined. Because of managerial pressure to reduce the time interval between general practitioner referral and first specialist assessment, many services are now faced with additional outpatient loads without any clear idea of the effect that this additional burden will have on overall practice. In an attempt to define the logistic implications of a new outpatient load, 293 patients, referred from primary care to a general urological service, were followed for a further two interactions with the secondary care team. 'One-stop' visits with in-clinic investigation and an active discharge policy were employed to assist with efficient patient management. Of the original patients, 28% required investigations not available in the clinic, with cost and logistic implications for support services. In all, 32% of the patients needed further follow-up appointments, despite the active discharge policy. This necessitated 95 people being seen in additional clinic time. Of the patients referred, 37% needed inpatient treatment; 46% being day case procedures, the remainder constituting a variable case mix. This work necessitated 7.1 operating sessions and an additional 75 inpatient bed days for every 100 new patients referred. A model for determining the resource requirements for a surgical outpatient load is proposed.
新门诊转诊对外科服务整体供给动态的影响此前尚未明确。由于存在管理压力，要求缩短全科医生转诊至首次专科评估之间的时间间隔，许多服务机构目前面临额外的门诊负担，却不清楚这种额外负担对整体业务会有何种影响。为了明确新增门诊负担的后勤保障问题，对293例从基层医疗转诊至普通泌尿外科服务的患者进行跟踪，观察其与二级医疗团队的另外两次互动情况。采用“一站式”门诊检查及积极的出院政策，以协助高效管理患者。在最初的患者中，28% 需要进行门诊无法开展的检查，这对支持服务的成本和后勤保障有一定影响。尽管实施了积极的出院政策，但总共仍有32% 的患者需要进一步的随访预约。这就需要额外安排门诊时间诊治95名患者。在转诊患者中，37% 需要住院治疗；46% 为日间手术，其余则构成了多样化的病例组合。每转诊100名新患者，这项工作需要7.1个手术时段以及额外75个住院床日。本文提出了一种确定外科门诊负担所需资源的模型。
