Evaluation of an After-Hours Call Center Are Pediatric Patients Appropriately Referred to the Emergency Department?
Evaluation of an After-Hours Call Center Are Pediatric Patients Appropriately Referred to the Emergency Department?
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DOI：
10.1097/pec.0000000000000262
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发表时间：
2014-11-01
影响因子：
1.4
通讯作者：
Olympia, Robert P.
中科院分区：
文献类型：
--
作者：
Doctor, Kaynan;Correa, Kelly;Olympia, Robert P.
背景：有人担心，非工作时间护士电话分诊系统会导致急诊室 (ED) 不堪重负，导致急诊科 (ED) 无法进行儿科转诊。目的：本研究旨在严格审查一家非儿科医院呼叫中心，旨在确定导致大多数非必要转诊的算法。方法：这是一项在三级医疗机构进行了 1 年多的回顾性观察研究。对 18 岁以下儿童和青少年的电话分诊表格进行了审查，这些表格由分诊护士使用 Barton Schmitt 协议专门转介，并通过查阅电子病历对他们的急诊科进行了评估。 “必要”转诊至急诊科的情况分为需要立即评估的转诊或需要“基本干预”的转诊，例如血清实验室检查、影像学、复杂手术、静脉药物、亚专科会诊或入院。 结果：本研究总共纳入 220 名患者。其中，73 个 (33%) 被归类为非必需品，而 147 个 (67%) 被归类为必需品。与必要转诊患者相比，非必要患者明显更年轻（P < 0.05）。他们的分诊分数也较低 (P = 0.026)，急诊科住院时间也较短 (P < 0.0001)。 “发烧 3 个月或以上”(12.3%)、“呕吐但不腹泻”(8.2%)、“头部外伤”(8.2%)、“头痛”(6.8%) 和“喉咙痛”(5.5%) 的算法被确定最有可能导致不必要的转诊。结论：我们的研究发现，三分之一不必要的儿科急诊就诊是由于护士分诊电话系统的问题造成的。我们建议审查所述算法，以减少当地 ED 资源的压力。
Background: There is concern that after-hours nurse telephone triage systems are overwhelming the emergency department (ED) with nonemergent pediatric referrals.Objectives: This study aimed to critically review a nonpediatric hospital-based call center with the aim of identifying the algorithms responsible for the majority of nonessential referrals.Methods: This is a retrospective observational study performed at a tertiary medical care facility over 1 year. Telephone triage forms of children and adolescents younger than 18 years, exclusively referred by triage nurses using the Barton Schmitt protocols, were reviewed, and their ED course was evaluated by consulting the electronic medical record. "Essential" referrals to the ED were classified as presentations warranting immediate evaluation or referrals requiring "essential interventions" such as serum laboratory tests, imaging, complex procedures, intravenous medications, subspecialty consultation, or admission.Results: A total of 220 patients were included in this study. Of these, 73 (33%) were classified as nonessential, whereas 147 (67%) were classified as essential. Nonessential patients were significantly younger compared with essential referrals (P < 0.05). They also had lower triage scores (P = 0.026) and shorter ED stays (P < 0.0001). The algorithms for "fever-3 months or older" (12.3%), "vomiting without diarrhea" (8.2%), "trauma-head" (8.2%), "headache" (6.8%), and "sore throat" (5.5%) were determined most likely to result in a nonessential referral.Conclusions: Our study identifies that a third of unnecessary pediatric visits to the ED occurred as a result of the nurse triage telephone system in question. We recommend review of the algorithms stated to reduce strain on local ED resources.