Speeding up the clinical pathways by accessing emergency departments
Speeding up the clinical pathways by accessing emergency departments
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DOI：
10.1007/s10198-019-01107-5
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发表时间：
2020-02-01
影响因子：
4.4
通讯作者：
Persico, Luca
中科院分区：
文献类型：
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作者：
Levaggi, Rosella;Montefiori, Marcello;Persico, Luca
不适当的急诊入院会造成人满为患，并可能降低急诊护理的质量。在意大利，病人把急诊作为避开全科医生的捷径，这进一步加剧了人满为患的情况。在本文中，我们调查了非严重疾病患者进入急诊科（EDs）的情况和他们的等待意愿。利用意大利利古里亚（Liguria） 2016年急诊科就诊人口数据，估算低危患者战略就诊次数和等待时间弹性。我们的研究结果表明，使用电子邮件跳过把关的做法是一个严重的问题。从事这种做法的患者比例从非紧急患者的8.7%到9.9%不等；他们通常更愿意去更专业的医院，特别是在工作日，当全科医生有空时，但医院满负荷运转。有策略的病人通常比一般人年轻得多。从政策的角度来看，我们的研究结果表明，长时间的等待可能会让“真正的”病人气馁，而不是让那些有策略的病人泄气。有必要建立一个系统，改善对主要需要专科护理的患者的可及性，同时通过初级保健加强对诊断检查的管理。
Inappropriate emergency admissions create overcrowding and may reduce the quality of emergency care. In Italy, overcrowding is further exacerbated by patients who use emergency admissions as a shortcut to avoid the general practitioner (GP) gateway. In this paper, we investigate access to emergency departments (EDs) by patients with non-severe medical conditions and their willingness to wait. Population data for ED accesses in Liguria (an Italian administrative region) in 2016 were used to estimate the number of strategic accesses and waiting time elasticities of low-severity patients. Our results show that the practice of using EDs to skip gatekeeping is a serious problem. The percentage of patients who engage in such practice vary from 8.7 to 9.9% of non-urgent patients; they generally prefer to access more specialized hospitals, especially during weekdays, when GPs are available, but hospitals run at full capacity. Strategic patients are usually much younger than average. From a policy point of view, our results show that long waits may discourage "genuine" patients rather than strategic ones. It is necessary to develop a system to improve access to patients mainly requiring specialist care, along with enhancing the management of diagnostic examinations through primary care.