Staffing of the ED by non-emergency medicine-trained personnel: the VA experience
Staffing of the ED by non-emergency medicine-trained personnel: the VA experience
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DOI：
10.1016/j.ajem.2009.04.025
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发表时间：
2010-06-01
影响因子：
3.6
通讯作者：
Pitzele, H. Zoltan
中科院分区：
文献类型：
--
作者：
Unterman, Sarah;Kessler, Chad;Pitzele, H. Zoltan
研究目标：VA（退伍军人事务部）急诊科（ED）通常配备接受过内科（IM）培训的医生，尽管最近开始出现雇用接受过急诊医学（EM）培训的工作人员的运动。在我们的机构，急诊科由两个专业的医生组成。本研究检查了计划外回急诊室的频率，以比较接受过 IM 和 EM 培训的医生提供的急诊护理的质量。方法：检查了 90 天内前往 VA 医院急诊室的所有就诊记录，并记录了在随后 30 天内导致急诊室回访的所有就诊记录。结果：检查了 2891 名连续 ED 患者的图表。 IM 培训医生的复诊率明显高于接受过 EM 培训的医生（分别为 8.9% 和 5.5%；P < .001）。接受过 IM 培训的医生 30 天内复诊的入院率显着高于接受过 EM 培训的医生（分别为 3.5% 和 1.9%；P = .014）。接受过 IM 培训的工作人员的初始住院率低于 EM 医生（分别为 20% 和 43%；P < .0001）。 结论：接受过 IM 培训的医生住院患者的可能性较小，尽管这可以部分解释为患者在他们所服务的时间里病情严重程度较低。经过 IM 培训的医生更有可能让患者出院后返回，也更有可能让需要住院治疗的患者返回。这可能反映了对 ED 患者的快速诊断和风险分层培训的差异。由爱思唯尔公司出版
Study objective: VA (Veteran's Affairs) emergency departments (EDs) are generally staffed with physicians trained in internal medicine (IM), although recently, a movement has begun toward hiring emergency medicine (EM)-trained staff. At our institution, the ED is staffed by physicians of both specialties. This study examines the frequency of unscheduled return visits to the ED in an effort to compare the quality of emergency care given by physicians trained in IM and EM.Methods: The record of all visits to a VA hospital ED during a 90-day period were examined, and all those visits resulting in a return ED visit within the 30 subsequent days were noted.Results: The charts of 2891 consecutive ED patients were examined. The rate of revisits was significantly higher for the IM than for the EM-trained physicians (8.9% vs 5.5%, respectively; P < .001). The IM-trained physicians had a significantly higher rate of admissions upon revisit within 30 days than did the EM-trained physicians (3.5% vs 1.9%, respectively; P = .014). The IM-trained staff had lower initial hospitalization rates than the EM physicians (20% vs 43%, respectively; P < .0001).Conclusions: The IM-trained physicians were less likely to hospitalize patients, although this can be partially explained by the lower acuity of patients during the hours that they covered. The IM-trained physicians were significantly more likely to have a patient return after discharge and also more likely to have a patient return in need of hospitalization. This may reflect a difference in training for the rapid diagnosis and risk stratification of ED patients. Published by Elsevier Inc.