Lattimer V, George S, Thompson F, Thomas E, Mullee M, Turnbull J, Smith H, Moore M, Bond H, Glasper A
Health Care Research Unit, Wessex Institute for Health Research and Development, Wessex.
BMJ. 1998 Oct 17;317(7165):1054-9. doi: 10.1136/bmj.317.7165.1054.
To determine the safety and effectiveness of nurse telephone consultation in out of hours primary care by investigating adverse events and the management of calls.
Block randomised controlled trial over a year of 156 matched pairs of days and weekends in 26 blocks. One of each matched pair was randomised to receive the intervention.
One 55 member general practice cooperative serving 97 000 registered patients in Wiltshire.
All patients contacting the out of hours service or about whom contact was made during specified times over the trial year.
A nurse telephone consultation service integrated within a general practice cooperative. The out of hours period was 615 pm to 1115 pm from Monday to Friday, 1100 am to 1115 pm on Saturday, and 800 am to 1115 pm on Sunday. Experienced and specially trained nurses received, assessed, and managed calls from patients or their carers. Management options included telephone advice; referral to the general practitioner on duty (for telephone advice, an appointment at a primary care centre, or a home visit); referral to the emergency service or advice to attend accident and emergency. Calls were managed with the help of decision support software.
Deaths within seven days of a contact with the out of hours service; emergency hospital admissions within 24 hours and within three days of contact; attendance at accident and emergency within three days of a contact; number and management of calls in each arm of the trial.
14 492 calls were received during the specified times in the trial year (7308 in the control arm and 7184 in the intervention arm) concerning 10 134 patients (10.4% of the registered population). There were no substantial differences in the age and sex of patients in the intervention and control groups, though male patients were underrepresented overall. Reasons for calling the service were consistent with previous studies. Nurses managed 49.8% of calls during intervention periods without referral to a general practitioner. A 69% reduction in telephone advice from a general practitioner, together with a 38% reduction in patient attendance at primary care centres and a 23% reduction in home visits was observed during intervention periods. Statistical equivalence was observed in the number of deaths within seven days, in the number of emergency hospital admissions, and in the number of attendances at accident and emergency departments. Conclusions Nurse telephone consultation produced substantial changes in call management, reducing overall workload of general practitioners by 50% while allowing callers faster access to health information and advice. It was not associated with an increase in the number of adverse events. This model of out of hours primary care is safe and effective.
通过调查不良事件及电话咨询管理情况，确定非工作时间基层医疗中护士电话咨询的安全性和有效性。
为期一年的整群随机对照试验，在26个区组中选取156对匹配的工作日和周末。每对匹配日中的一天随机分配接受干预。
一个有55名成员的全科医疗合作社，为威尔特郡97000名注册患者提供服务。
在试验年度特定时间内联系非工作时间服务或被联系的所有患者。
在全科医疗合作社内整合的护士电话咨询服务。非工作时间为周一至周五下午6:15至晚上11:15，周六上午11:00至晚上11:15，周日上午8:00至晚上11:15。经验丰富且经过专门培训的护士接听、评估并处理患者或其护理人员的来电。处理方式包括电话建议；转介给值班全科医生（以获取电话建议、在基层医疗中心预约或上门问诊）；转介至急救服务机构或建议前往事故与急救部门。借助决策支持软件处理来电。
与非工作时间服务联系后7天内的死亡情况；联系后24小时内及3天内的急诊入院情况；联系后3天内前往事故与急救部门就诊的情况；试验各组的来电数量及处理情况。
试验年度特定时间内共接到14492个电话（对照组7308个，干预组7184个），涉及10134名患者（占注册人口的10.4%）。干预组和对照组患者的年龄和性别无显著差异，不过总体上男性患者比例偏低。致电该服务的原因与既往研究一致。在干预期间，护士处理了49.8%的来电，无需转介给全科医生。在干预期间，全科医生提供的电话建议减少了69%，患者前往基层医疗中心就诊的次数减少了38%，上门问诊次数减少了23%。在7天内的死亡人数、急诊入院人数以及前往事故与急救部门就诊的人数方面观察到统计学等效性。结论护士电话咨询在来电处理方面产生了重大变化，将全科医生的总体工作量减少了50%，同时使来电者能更快获取健康信息和建议。且未导致不良事件数量增加。这种非工作时间基层医疗模式安全有效。
