PDF(Pubmed)
Abstract：
OBJECTIVE: The Symptom and Urgent Review Clinic was a service improvement initiative, which consisted of the implementation and evaluation of a nurse-led emergency department (ED) avoidance model of care. The clinic was developed for patients experiencing symptoms associated with systemic anti-cancer therapy in ambulatory cancer settings.
METHODS: The clinic was implemented in four health services in Melbourne, Australia across a six-month period in 2018. Evaluation was by prospective data collection of the frequency and characteristics of patients who used the service, pre- and post-survey of patient reported experience, and a post-implementation survey of clinician engagement and experience.
RESULTS: There were 3095 patient encounters in the six-month implementation period; 136 patients were directly admitted to inpatient healthcare services after clinic utilization. Of patients who contacted SURC (n = 2174), a quarter (n = 553) stated they would have otherwise presented to the emergency department and 51% (n = 1108) reported they would have otherwise called the Day Oncology Unit. After implementation, more patients reported having a dedicated point of contact (OR 14.3; 95% CI 5.8-37.7) and ease of contacting the nurse (OR 5.5; 95% CI 2.6-12.1). Clinician reported experience and engagement with the clinic was highly favorable.
CONCLUSIONS: The nurse-led emergency department avoidance model of care addressed a gap in service delivery, while optimizing service utilization by reducing ED presentations. Patients reported improved levels of satisfaction with ease of access to a dedicated nurse and advice provided.
METHODS: The clinic was implemented in four health services in Melbourne, Australia across a six-month period in 2018. Evaluation was by prospective data collection of the frequency and characteristics of patients who used the service, pre- and post-survey of patient reported experience, and a post-implementation survey of clinician engagement and experience.
RESULTS: There were 3095 patient encounters in the six-month implementation period; 136 patients were directly admitted to inpatient healthcare services after clinic utilization. Of patients who contacted SURC (n = 2174), a quarter (n = 553) stated they would have otherwise presented to the emergency department and 51% (n = 1108) reported they would have otherwise called the Day Oncology Unit. After implementation, more patients reported having a dedicated point of contact (OR 14.3; 95% CI 5.8-37.7) and ease of contacting the nurse (OR 5.5; 95% CI 2.6-12.1). Clinician reported experience and engagement with the clinic was highly favorable.
CONCLUSIONS: The nurse-led emergency department avoidance model of care addressed a gap in service delivery, while optimizing service utilization by reducing ED presentations. Patients reported improved levels of satisfaction with ease of access to a dedicated nurse and advice provided.
摘要：
目标：症状和紧急检查诊所是一项服务改进计划，其中包括实施和评估护士主导的急诊科（ED）回避护理模式。该诊所是为在门诊癌症环境中出现与全身抗癌治疗相关症状的患者开发的。
方法：该诊所在墨尔本的四个卫生服务机构中实施，澳大利亚在2018年的六个月期间。评估是通过前瞻性数据收集使用该服务的患者的频率和特征，患者报告体验调查前后，以及临床医生参与和经验的实施后调查。
结果：在6个月的实施期内，有3095名患者相遇；136名患者在诊所使用后直接进入住院医疗服务。在接触SURC的患者中（n=2174），四分之一（n=553）表示他们本来会向急诊科就诊，而51％（n=1108）表示他们本来会被称为Day肿瘤科。实施后，更多患者报告有专门的接触点(OR14.3;95%CI5.8~37.7),且易于与护士联系(OR5.5;95%CI2.6~12.1).临床医生报告说，经验和对诊所的参与非常有利。
结论：护士主导的急诊科回避护理模式解决了服务提供方面的差距，同时通过减少ED演示文稿来优化服务利用率。患者报告满意度提高，易于获得专职护士和提供建议。
方法：该诊所在墨尔本的四个卫生服务机构中实施，澳大利亚在2018年的六个月期间。评估是通过前瞻性数据收集使用该服务的患者的频率和特征，患者报告体验调查前后，以及临床医生参与和经验的实施后调查。
结果：在6个月的实施期内，有3095名患者相遇；136名患者在诊所使用后直接进入住院医疗服务。在接触SURC的患者中（n=2174），四分之一（n=553）表示他们本来会向急诊科就诊，而51％（n=1108）表示他们本来会被称为Day肿瘤科。实施后，更多患者报告有专门的接触点(OR14.3;95%CI5.8~37.7),且易于与护士联系(OR5.5;95%CI2.6~12.1).临床医生报告说，经验和对诊所的参与非常有利。
结论：护士主导的急诊科回避护理模式解决了服务提供方面的差距，同时通过减少ED演示文稿来优化服务利用率。患者报告满意度提高，易于获得专职护士和提供建议。
