Kini N M, Strait R T
Medical College of Wisconsin, Department of Pediatrics, Milwaukee, USA.
Pediatr Emerg Care. 1998 Feb;14(1):19-21. doi: 10.1097/00006565-199802000-00005.
To evaluate the pattern and reasons for nonurgent use of the pediatric emergency department (PED) during regular office hours and why primary care physicians (PCP) approve such visits.
Prospective, cross-sectional, observational study.
Free-standing, university-affiliated children's hospital emergency department.
Patients presenting to the PED and triaged as nonurgent between June and November 1994, Monday through Friday from 6:30 am to 6:30 pm, and Saturday 6:30 am to 12:00 noon.
Registration and triage information and all communication with the PCP.
Of 1020 eligible patients, 364 patients and their PCP completed the study. Fifty-two percent of the study patients were enrolled in a health maintenance organization (HMO). This is consistent with the penetration of managed care in this community. Most HMO (118 of 191, 62%) and non-HMO enrollees (147 of 173, 86%) did not call their PCP prior to arrival in the PED. Comparing the reasons given by these patients (HMO enrollees versus non-HMO) for not calling, we found: convenience (HMO 17% vs non-HMO 4%, P < 0.01), "no identified PCP" (HMO 17% vs non-HMO 42%, P < 0.01), and "felt problem was an emergency" (HMO 19% vs non-HMO 10%, P = 0.03) to be important differences. HMO enrollees received approval for the visit 79% of the time. These approvals were mostly after noon, whereas most denials occurred before noon. We found a pattern in the reason for approvals. Before 3:30 pm, the most common reason was that the PCP "considered the problem medically urgent" (48 out of 106). After 3:30 pm, without significant difference in the pattern of patient's chief complaints, there was a dramatic change to "a full office schedule" (25 out of 45) as the most common reason.
Communication between the patient and PCP prior to the PED visit is poor in the study population. Convenience and physician workload appear to be important factors in the choice to use the PED for nonurgent problems.
评估在正常办公时间非紧急情况下小儿急诊科（PED）的使用模式及原因，以及初级保健医生（PCP）批准此类就诊的原因。
前瞻性、横断面观察性研究。
独立的、与大学相关的儿童医院急诊科。
1994年6月至11月期间，周一至周五上午6:30至下午6:30以及周六上午6:30至中午12:00就诊于PED且被分诊为非紧急情况的患者。
登记和分诊信息以及与PCP的所有沟通。
在1020名符合条件的患者中，364名患者及其PCP完成了研究。52%的研究患者加入了健康维护组织（HMO）。这与该社区管理式医疗的渗透率一致。大多数HMO参保者（191名中的118名，62%）和非HMO参保者（173名中的147名，86%）在到达PED之前未联系他们的PCP。比较这些患者（HMO参保者与非HMO参保者）不联系的原因，我们发现：便利性（HMO为17%，非HMO为4%，P<0.01）、“未确定PCP”（HMO为17%，非HMO为42%，P<0.01）以及“感觉问题是紧急情况”（HMO为19%，非HMO为10%，P = 0.03）是重要差异。HMO参保者就诊获得批准的时间为79%。这些批准大多在中午之后，而大多数拒绝发生在中午之前。我们发现了批准原因的一种模式。下午3:30之前，最常见的原因是PCP“认为问题在医学上紧急”（106例中的48例）。下午3:30之后，在患者主要诉求模式无显著差异的情况下，最常见的原因急剧变为“全天门诊安排已满”（45例中的25例）。
在研究人群中，患者与PCP在就诊于PED之前的沟通较差。便利性和医生工作量似乎是选择在非紧急问题时使用PED的重要因素。
