Impact of employing primary healthcare professionals in emergency department triage on patient flow outcomes: a systematic review and meta-analysis.
Impact of employing primary healthcare professionals in emergency department triage on patient flow outcomes: a systematic review and meta-analysis.
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DOI：
10.1136/bmjopen-2021-052850
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发表时间：
2022-04-20
期刊：
影响因子：
2.9
通讯作者：
Abou-Setta, Ahmed M.
中科院分区：
文献类型：
--
作者：
Jeyaraman, Maya M.;Alder, Rachel N.;Copstein, Leslie;Al-Yousif, Nameer;Suss, Roger;Zarychanski, Ryan;Doupe, Malcolm B.;Berthelot, Simon;Mireault, Jean;Tardif, Patrick;Askin, Nicole;Buchel, Tamara;Rabbani, Rasheda;Beaudry, Thomas;Hartwell, Melissa;Shimmin, Carolyn;Edwards, Jeanette;Halas, Gayle;Sevcik, William;Tricco, Andrea C.;Chochinov, Alecs;Rowe, Brian H.;Abou-Setta, Ahmed M.
识别、批判性评估和总结证据，说明在急诊科 (ED) 分诊中雇用初级卫生保健专业人员（PHCP：家庭医生/全科医生 (GP)、执业护士 (NP) 和具有更高权力的护士）对患者流程结果的影响。我们检索了 Medline (Ovid)、EMBASE (Ovid)、Cochrane Library (Wiley) 和 CINAHL (EBSCO)（成立至 2020 年 1 月）。我们的主要结果是提供初步评估（PIA）的时间。次要结局包括分诊时间、未就诊而离开的患者比例 (LWBS)、住院时间 (ED LOS)、不听医嘱离开的患者比例 (LAMA)、急诊室重复就诊次数和患者满意度。两名独立评审员使用国家健康与护理卓越研究所质量评估工具选择研究、提取数据并评估研究质量。从 23973 条记录中，纳入了 40 项比较研究，其中包括 10 项随机对照试验 (RCT) 和 13 项前后研究。 PHCP 干预由 NP (n=14)、GP (n=3) 或在分诊时具有更高权威的护士 (n=23) 领导。在所有研究中，将 PHCP 主导的干预效果与传统护士主导的分诊模式进行了比较。干预的中位持续时间为 6 个月。研究质量普遍较低（混杂偏倚）； 7 个随机对照试验被归类为中等质量。大多数研究报告称，PHCP 主导的分诊干预措施减少了 PIA (13/14)、ED LOS (29/30)、患者 LWBS 比例 (8/10)、分诊时间 (3/3) 和重复 ED 就诊时间 (5/6)，并提高了患者满意度 (8/10)。 LAMA 患者的比例在各组之间没有差异 (3/3)。随机对照试验 (n=8) 以及其他研究设计的证据表明，ED LOS 显着降低，有利于 PHCP 主导的干预措施。总体而言，以 PHCP 为主导的分诊干预措施改善了 ED 患者流量指标。无论研究设计如何，ED LOS 均显着下降，有利于 PHCP 主导的干预措施。在广泛实施之前，需要来自精心设计的高质量随机对照试验的证据。 CRD42020148053。
To identify, critically appraise and summarise evidence on the impact of employing primary healthcare professionals (PHCPs: family physicians/general practitioners (GPs), nurse practitioners (NP) and nurses with increased authority) in the emergency department (ED) triage, on patient flow outcomes. We searched Medline (Ovid), EMBASE (Ovid), Cochrane Library (Wiley) and CINAHL (EBSCO) (inception to January 2020). Our primary outcome was the time to provider initial assessment (PIA). Secondary outcomes included time to triage, proportion of patients leaving without being seen (LWBS), length of stay (ED LOS), proportion of patients leaving against medical advice (LAMA), number of repeat ED visits and patient satisfaction. Two independent reviewers selected studies, extracted data and assessed study quality using the National Institute for Health and Care Excellence quality assessment tool. From 23 973 records, 40 comparative studies including 10 randomised controlled trials (RCTs) and 13 pre–post studies were included. PHCP interventions were led by NP (n=14), GP (n=3) or nurses with increased authority (n=23) at triage. In all studies, PHCP-led intervention effectiveness was compared with the traditional nurse-led triage model. Median duration of the interventions was 6 months. Study quality was generally low (confounding bias); 7 RCTs were classified as moderate quality. Most studies reported that PHCP-led triage interventions decreased the PIA (13/14), ED LOS (29/30), proportion of patients LWBS (8/10), time to triage (3/3) and repeat ED visits (5/6), and increased the patient satisfaction (8/10). The proportion of patients LAMA did not differ between groups (3/3). Evidence from RCTs (n=8) as well as other study designs showed a significant decrease in ED LOS favouring the PHCP-led interventions. Overall, PHCP-led triage interventions improved ED patient flow metrics. There was a significant decrease in ED LOS irrespective of the study design, favouring the PHCP-led interventions. Evidence from well-designed high-quality RCTs is required prior to widespread implementation. CRD42020148053.
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影响因子：
8.4
作者：
Khangura, Jaspreet K.;Flodgren, Gerd;Perera, Rafael;Rowe, Brian H.;Shepperd, Sasha
通讯作者：
Shepperd, Sasha
DOI：
10.1136/emermed-2012-201113
发表时间：
2013-02
期刊：
Emergency medicine journal : EMJ
影响因子：
--
作者：
Day TE;Al-Roubaie AR;Goldlust EJ
通讯作者：
Goldlust EJ
影响因子：
8.1
作者：
Jennings, Natasha;Clifford, Stuart;Gardner, Glenn
通讯作者：
Gardner, Glenn
影响因子：
3.1
作者：
Kirkland, Scott William;Soleimani, Amir;Newton, Amanda S.
通讯作者：
Newton, Amanda S.
影响因子：
3.1
作者：
Fatovich, DM;Hirsch, RL
通讯作者：
Hirsch, RL