Denman-Johnson M, Bingham P, George S
Isle of Wight Health Authority, Newport.
J Epidemiol Community Health. 1997 Aug;51(4):386-90. doi: 10.1136/jech.51.4.386.
To quantify the proportion of potentially avoidable emergency short term admissions to hospital and to identify ways in which they could have been avoided.
Confidential enquiry by peer review group.
St Mary's Hospital, Newport, Isle of Wight.
All emergency, short term admissions (discharged home within five days) to medicine, general surgery, orthopaedics, gynaecology, ENT, and ophthalmology specialties for 28 (24 hour) days over a six month period in 1994.
Appropriateness of admissions decided by the peer group, the peer group's opinion of ideal management, and the patients' views on the appropriateness of their admission.
Altogether 139 cases satisfied the inclusion criteria. Complete data were collected on 123 cases and the peer group considered 81 in the time available. Twenty one of the 81 cases were judged "potentially avoidable". These represent 9.5% (95% CI 6.3%, 13.5%) of short term admissions to the specialties studied. The peer group considered that seven of 10 patients referred by a general practitioner (GP) could have been managed by the GP alone and that the remaining three had been referred appropriately but need not have been admitted had a consultant opinion been available in the accident and emergency (A&E) department. Two of the 10 would have required home support to avoid hospital admission. Five of 11 patients who referred themselves to A&E could have been discharged home without admission and without recourse to a specialist opinion. The remaining six could have been discharged had a consultant opinion been available in A&E.
Urgent consultant opinion, either in A&E or in an outpatient clinic, would have prevented most of these inappropriate admissions, and home support would have expedited the ability to discharge some patients. Further research into the costs and benefits of methods for providing these services is needed urgently.
量化医院急诊短期入院中潜在可避免情况的比例，并确定可避免这些情况的方法。
由同行评审小组进行的保密调查。
怀特岛纽波特的圣玛丽医院。
1994年6个月期间内，连续28个（24小时）日内向内科、普通外科、骨科、妇科、耳鼻喉科和眼科专科进行的所有急诊短期入院（5天内出院回家）病例。
同行小组判定的入院合理性、同行小组对理想管理方式的意见以及患者对其入院合理性的看法。
共有139例病例符合纳入标准。收集了123例病例的完整数据，同行小组在可用时间内审议了81例。81例病例中有21例被判定为“潜在可避免”。这些病例占所研究专科短期入院病例的9.5%（95%可信区间6.3%，13.5%）。同行小组认为，全科医生（GP）转诊的10例患者中有7例本可由全科医生单独处理，其余3例转诊恰当，但如果急诊（A&E）部门能提供会诊意见，则无需入院。10例中有2例若要避免入院需要家庭支持。11例自行前往急诊的患者中有5例本可在不入院且无需专科意见的情况下出院回家。其余6例若急诊能提供会诊意见本可出院。
在急诊或门诊提供紧急会诊意见可避免大多数此类不恰当入院情况，家庭支持可加快部分患者出院。迫切需要进一步研究提供这些服务的方法的成本和效益。
