PDF(Pubmed)
Abstract：
BACKGROUND: Utilisation of the Emergency Department (ED) for non-urgent care increases demand for services, therefore reducing inappropriate or avoidable attendances is an important area for intervention in prevention of ED crowding. This study aims to develop a consensus between clinicians across care settings about the \"appropriateness\" of attendances to the ED in Ireland.
METHODS: The Better Data, Better Planning study was a multi-centre, cross-sectional study investigating factors influencing ED utilisation in Ireland. Data was compiled in patient summary files which were assessed for measures of appropriateness by an academic General Practitioner (GP) and academic Emergency Medicine Consultant (EMC) National Panel. In cases where consensus was not reached charts were assessed by an Independent Review Panel (IRP). At each site all files were autonomously assessed by local GP-EMC panels.
RESULTS: The National Panel determined that 11% (GP) to 38% (EMC) of n = 306 lower acuity presentations could be treated by a GP within 24-48 h (k = 0.259; p < 0.001) and that 18% (GP) to 35% (EMC) of attendances could be considered \"inappropriate\" (k = 0.341; p < 0.001). For attendances deemed \"appropriate\" the admission rate was 47% compared to 0% for \"inappropriate\" attendees. There was no consensus on 45% of charts (n = 136). Subset analysis by the IRP determined that consensus for appropriate attendances ranged from 0 to 59% and for inappropriate attendances ranged from 0 to 29%. For the Local Panel review (n = 306) consensus on appropriateness ranged from 40 to 76% across ED sites.
CONCLUSIONS: Multidisciplinary clinicians agree that \"inappropriate\" use of the ED in Ireland is an issue. However, obtaining consensus on appropriateness of attendance is challenging and there was a significant cohort of complex heterogenous presentations where agreement could not be reached by clinicians in this study. This research again demonstrates the complexity of ED crowding, the introduction of evidence-based care pathways targeting avoidable presentations may serve to alleviate the problem in our EDs.
METHODS: The Better Data, Better Planning study was a multi-centre, cross-sectional study investigating factors influencing ED utilisation in Ireland. Data was compiled in patient summary files which were assessed for measures of appropriateness by an academic General Practitioner (GP) and academic Emergency Medicine Consultant (EMC) National Panel. In cases where consensus was not reached charts were assessed by an Independent Review Panel (IRP). At each site all files were autonomously assessed by local GP-EMC panels.
RESULTS: The National Panel determined that 11% (GP) to 38% (EMC) of n = 306 lower acuity presentations could be treated by a GP within 24-48 h (k = 0.259; p < 0.001) and that 18% (GP) to 35% (EMC) of attendances could be considered \"inappropriate\" (k = 0.341; p < 0.001). For attendances deemed \"appropriate\" the admission rate was 47% compared to 0% for \"inappropriate\" attendees. There was no consensus on 45% of charts (n = 136). Subset analysis by the IRP determined that consensus for appropriate attendances ranged from 0 to 59% and for inappropriate attendances ranged from 0 to 29%. For the Local Panel review (n = 306) consensus on appropriateness ranged from 40 to 76% across ED sites.
CONCLUSIONS: Multidisciplinary clinicians agree that \"inappropriate\" use of the ED in Ireland is an issue. However, obtaining consensus on appropriateness of attendance is challenging and there was a significant cohort of complex heterogenous presentations where agreement could not be reached by clinicians in this study. This research again demonstrates the complexity of ED crowding, the introduction of evidence-based care pathways targeting avoidable presentations may serve to alleviate the problem in our EDs.
摘要：
背景：使用急诊科（ED）进行非紧急护理会增加对服务的需求，因此，减少不适当或可避免的出勤率是预防ED拥挤的重要干预领域。这项研究旨在在不同护理环境的临床医生之间就爱尔兰ED的就诊“适当性”达成共识。
方法：更好的数据，更好的规划研究是一个多中心，横断面研究调查影响爱尔兰ED利用率的因素。数据是在患者摘要文件中汇编的，由学术的全科医生（GP）和学术的急诊医学顾问（EMC）国家小组评估适当性。在未达成共识的情况下，由独立审查小组（IRP）评估图表。在每个站点，所有文件都由本地GP-EMC小组自主评估。
结果：国家小组确定，n=306的低视力表现中的11％（GP）至38％（EMC）可以在24-48小时内通过GP治疗（k=0.259；p<0.001），而18％（GP）至35％（EMC）的出勤率可以被认为是“不适当的”（k=0.341；p<0.001）。对于被认为“适当”的出席者，录取率为47％，而“不适当”的出席者为0％。45%的图表没有达成共识(n=136)。IRP的子集分析确定，适当出勤率的共识范围为0至59％，不适当出勤率的共识范围为0至29％。对于本地小组的审查（n=306），ED站点对适当性的共识范围为40％至76％。
结论：多学科临床医生一致认为在爱尔兰“不当”使用ED是一个问题。然而,就出诊的适当性达成共识是一项挑战,在这项研究中,有大量复杂的异质性陈述,临床医师无法达成一致.这项研究再次证明了ED拥挤的复杂性，以可避免的就诊为目标的循证护理路径的引入可能有助于缓解我们ED中的问题.
方法：更好的数据，更好的规划研究是一个多中心，横断面研究调查影响爱尔兰ED利用率的因素。数据是在患者摘要文件中汇编的，由学术的全科医生（GP）和学术的急诊医学顾问（EMC）国家小组评估适当性。在未达成共识的情况下，由独立审查小组（IRP）评估图表。在每个站点，所有文件都由本地GP-EMC小组自主评估。
结果：国家小组确定，n=306的低视力表现中的11％（GP）至38％（EMC）可以在24-48小时内通过GP治疗（k=0.259；p<0.001），而18％（GP）至35％（EMC）的出勤率可以被认为是“不适当的”（k=0.341；p<0.001）。对于被认为“适当”的出席者，录取率为47％，而“不适当”的出席者为0％。45%的图表没有达成共识(n=136)。IRP的子集分析确定，适当出勤率的共识范围为0至59％，不适当出勤率的共识范围为0至29％。对于本地小组的审查（n=306），ED站点对适当性的共识范围为40％至76％。
结论：多学科临床医生一致认为在爱尔兰“不当”使用ED是一个问题。然而,就出诊的适当性达成共识是一项挑战,在这项研究中,有大量复杂的异质性陈述,临床医师无法达成一致.这项研究再次证明了ED拥挤的复杂性，以可避免的就诊为目标的循证护理路径的引入可能有助于缓解我们ED中的问题.
