What is the evidence for the management of patients along the pathway from the emergency department to acute admission to reduce unplanned attendance and admission? An evidence synthesis
What is the evidence for the management of patients along the pathway from the emergency department to acute admission to reduce unplanned attendance and admission? An evidence synthesis
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DOI：
10.1186/s12913-017-2299-8
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发表时间：
2017-05-16
影响因子：
2.8
通讯作者：
Whiteside, Mike
中科院分区：
文献类型：
--
作者：
Crede, Sarah H.;O'Keeffe, Colin;Whiteside, Mike
背景：在全球范围内，急诊住院率正在上升。然而，很少有证据表明，发展干预措施，以减少计划外急诊室（ED）的出席率和住院率。本证据综合的目的是审查干预措施的证据，这些干预措施是在患者通过急诊科或急症护理机构的过程中进行的，目的是对病情恶化的患者进行管理，以减少计划外的急诊住院率和入院率。方法：对2000-2014年MEDLINE、EMBASE、CINAHL、Cochrane Library和Web of Science等电子数据库进行系统文献检索，进行快速证据合成。本综述纳入的证据仅限于同行评议期刊上报道的随机对照试验（RCTs）和观察性研究（含对照组）。评估对急诊科或急症护理机构中出现急症急性加重的患者进行干预的研究，这些研究报告了至少一项与急诊科就诊或计划外入院相关的结果。结果：30篇论文符合我们的纳入标准：19项干预研究（14项随机对照试验）和11项对照观察性研究。16项研究是在急诊科进行的，14项是在急症室进行的。在急诊科进行的两项研究（一项随机对照试验）有效地降低了急诊科的出勤率和住院率。这两种干预措施都是在急诊科开始的，包括出院后的社区成分。矛盾的是，ED发起的干预显示ED的再出勤率增加。六项研究（1项随机对照试验）在急症护理环境中有效地降低了住院率、急症室复诊率或再入院率（两项在观察病房，一项在急症室评估单元，三项在入院后72小时内进行干预）。结论：没有明确的证据表明，从患者到达急诊科到入院后72小时的特定干预措施有利于急诊科的再次就诊或再入院。针对高危患者的干预措施，特别是老年人，可能会减少ED的使用，值得未来的研究。一些干预措施在减少计划外急诊科就诊率和入院率方面显示出有效性，这些干预措施是由经过适当培训的人员在一个允许有足够时间评估和管理患者的环境中提供的。
Background: Globally, the rate of emergency hospital admissions is increasing. However, little evidence exists to inform the development of interventions to reduce unplanned Emergency Department (ED) attendances and hospital admissions. The objective of this evidence synthesis was to review the evidence for interventions, conducted during the patient's journey through the ED or acute care setting, to manage people with an exacerbation of a medical condition to reduce unplanned emergency hospital attendance and admissions.Methods: A rapid evidence synthesis, using a systematic literature search, was undertaken in the electronic data bases of MEDLINE, EMBASE, CINAHL, the Cochrane Library and Web of Science, for the years 2000-2014. Evidence included in this review was restricted to Randomised Controlled Trials (RCTs) and observational studies (with a control arm) reported in peer-reviewed journals. Studies evaluating interventions for patients with an acute exacerbation of a medical condition in the ED or acute care setting which reported at least one outcome related to ED attendance or unplanned admission were included.Results: Thirty papers met our inclusion criteria: 19 intervention studies (14 RCTs) and 11 controlled observational studies. Sixteen studies were set in the ED and 14 were conducted in an acute setting. Two studies (one RCT), set in the ED were effective in reducing ED attendance and hospital admission. Both of these interventions were initiated in the ED and included a post-discharge community component. Paradoxically 3 ED initiated interventions showed an increase in ED re-attendance. Six studies (1 RCT) set in acute care settings were effective in reducing: hospital admission, ED re-attendance or re-admission (two in an observation ward, one in an ED assessment unit and three in which the intervention was conducted within 72 h of admission).Conclusions: There is no clear evidence that specific interventions along the patient journey from ED arrival to 72 h after admission benefit ED re-attendance or readmission. Interventions targeted at high-risk patients, particularly the elderly, may reduce ED utilization and warrant future research. Some interventions showing effectiveness in reducing unplanned ED attendances and admissions are delivered by appropriately trained personnel in an environment that allows sufficient time to assess and manage patients.