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Inappropriate use of an accident and emergency department:: Magnitude, associated factors, and reasons -: An approach with explicit criteria

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ANNALS OF EMERGENCY MEDICINE 2001年第6期37卷 568-579页

作者： Sempere-Selva, T Peiró, S Sendra-Pina, P Martínez-Espín, C López-Aguilera, I Fdn Inst Invest Serv Salud Valencia 46008 Spain Hosp Morales Meseguer Serv Urgencias Murcia Spain Hosp Gen Univ Serv Urgencias Elche Spain

Background: We evaluate the appropriateness of medical visits to the accident and emergency department (A&ED) of a university hospital using an instrument based on explicit and objective criteria, analyze the association between inappropriate visits and certain factors, and identify reasons for inappropriate use. Methods: This concurrent review of a random sample of 2,980 adult medical patients' visits to the A&ED of the hospital of Elche uses the Hospital Urgencies Appropriateness Protocol, an instrument based on explicit criteria. We analyze the association between inappropriate use and specific factors, and provide a descriptive analysis of reasons for inappropriate use assigned by A&ED staff. Results: Of the total number, 882 (29.6%) of the visits were evaluated as inappropriate. Inappropriate use was associated with younger patients, use of own means of transportation, referral by the hospital, certain months of the year, and certain diagnostic groups of lesser severity. The most frequent reasons for inappropriate use were the patients' greater trust in the hospital than primary care (451 [51.1%]), inappropriate use of services by patients (160 [18.1%]), and inappropriate referrals by primary care physicians (142 [16.1%]). Conclusion: Inappropriate use represents an important percentage of use of the A&ED. Many reasons contribute to it, although foremost among them is patient preference (and the convenience and accessibility) of these services compared with primary care.

关键词：年龄因素住院期间审核交叉研究诊断相关患者组/分类诊断相关患者组/统计学和数值数据急诊室医院/利用卫生服务滥用/统计学和数值数据卫生服务研究医院公立/利用医院大学/利用病人接受卫生保健的程度/心理学病人接受卫生保健的程度/统计学和数值数据初级卫生保健/利用问卷调查转诊和会诊/组织和管理居住特征/统计学和数值数据危险因素疾病严重程度指数西班牙/流行病学运输/统计学和数值数据成年人老年人女(雌)性人类男(雄)性中年人

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Diagnostic imaging facilities for the general practitioner

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NETHERLANDS JOURNAL OF MEDICINE 2000年第4期57卷 133-134页

作者： Mali, WPTM UMC Utrecht Dept Radiol NL-3508 GA Utrecht Netherlands

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Formula for surgical practice resuscitation in an academic medical center

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AMERICAN JOURNAL OF SURGERY 2000年第5期179卷 417-421页

作者： Sinanan, M Wicks, K Peccoud, M Canfield, J Poser, L Sailer, L Stephens, K Edwards, D Univ Washington Sch Med Dept Surg Seattle WA 98195 USA Univ Washington Med Ctr Div Patient Care Serv Seattle WA 98195 USA Univ Washington Med Ctr Div Patient Admitting & Registrat Seattle WA 98195 USA Univ Washington Med Ctr Div Med Ctr Informat Syst Seattle WA 98195 USA

BACKGROUND: Managing patient referrals for surgical consultation in an academic practice has traditionally emphasized clinical rather than service expertise. However, assuring both efficiency and accuracy in the initial consultation have become critical early measures of quality care. METHODS: In partnership with the academic medical center administration, current practice was analyzed. Performance and communication standards were established around an ideal patient experience. A new ambulatory consultation process was developed;and flowcharting methods for resource allocation, statistical process control, and pre-visit data collection were used to reduce patient administrative time. Automated referral reports engaged referring physicians throughout the consultation, RESULTS: Accurate insurance and referral authorization have been provided for all patients, including the 4% who are underinsured. Patient, provider, and referring physician satisfaction has increased significantly. Staff time investment has progressively declined from 52 +/- 11 (95% confidence) minutes to 34 +/- 10 minutes for most patients. Realignment of tasks has reduced the administrative time spent by the patient by 32% without compromising clinical time. New patient volume increased by 29% per year, maintaining regional market share. CONCLUSIONS: Expertise in the process of consultation delivery is feasible and will be increasingly critical to the survival of academic surgical practice in a competitive market. (C) 2000 by Excerpta Medica, Inc.

关键词：诊疗工作管理医学/组织和管理方案评价质量指标卫生保健转诊和会诊/组织和管理软件设计外科学/组织和管理全面质量管理/组织和管理华盛顿

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AN OVERVIEW OF NETWORKING FOR PHYSICIANS AND PROBLEMS OF NETWORK CONSULTING IN REMOTE AREAS

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ANNALS OF THE NEW YORK ACADEMY OF SCIENCES-SERIES 1992年第1期670卷 19-28页

作者： LISSE, EW Department of Obstetrics and Gynecology Katutura State Hospital Windhoek Namibia

For computer networking the most suitable operating systems are UNIX or MS-DOS. As networking software UUCP and TCP/IP are most common. Hardware requirements are derived from the operating system and from the networking software. Low-cost solutions, for example, uuPC, a public domain version of UUCP, require only an 8088 processor and a 2400-baud modem. TCP/IP fares better with more powerful processors and requires permanent lines between the connecting computers. In developing countries the introduction of computer networks is hampered by several factors: lack of foreign exchange, price of hardware and software, unreliable electricity and telephone lines, lack of hardware and software support, large distances to the nearest center, and incompatibilities between existing systems and the network. Important aspects for clinical networking in developing countries include appointment scheduling in the referral hospitals, access to laboratory and pathology results from the central laboratory, and primary health care information such as epidemiologic data. Advanced systems, for example, for image processing, are not yet feasible in developing countries.

关键词：计算机通信网络/组织和管理数据库管理系统发展中国家缺医地区微型计算机纳米比亚办公室自动化转诊和会诊/组织和管理软件远程医学/组织和管理

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Direct access day case oral surgery

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BRITISH DENTAL JOURNAL 2000年第8期188卷 452-456页

作者： Joshi, A Doyle, L Worthington, HV Rood, JP Manchester Royal Infirm Dept Oral & Maxillofacial Surg Manchester M13 9WL Lancs England Univ Manchester Dent Hosp Dept Dent Med & Surg Manchester M15 6FH Lancs England GKT Sch Dent London SE5 9RW England

Objective To compare the effectiveness of direct access referrals with standard letter referrals, and also assess the impact of the direct access system on the primary care provider, secondary sector and from the patients perspective. Design Surgical and anaesthetic guidelines were agreed and 12 general dental practitioners were recruited to participate in the study. Each practitioner was given 100 envelopes which contained randomly allocated 50 direct and 50 standard referrals. For direct referrals, GDPs completed a pre-operative assessment and obtained an operation date by telephone from the day case unit while the patient was in the surgery. The clinical history sheet was fared to the day unit and the radiographs posted. The only contact the patient had with the hospital was on the day of surgery. Standard referral patients were referred in the traditional way with a referral letter being sent to an out-patient clinic. Evaluation of the effectiveness of the direct referral system versus standard letter method were made via completion of questionnaires by the patients, dental practitioners, hospital clinicians, day case anaesthetist and co-ordinator. Setting The study was carried out over 2 years commencing in 1997 at the Oral Surgery Day Case Unit at Manchester Royal Infirmary. Results A greater number of direct access referrals (409;90%) were treated in comparison with (312;75%) standard referrals IP < 0.001). Eighty nine per cent of direct access records were adequate pre-operatively. More than 70% of dentists and hospital clinicians preferred the direct access referral method. Sixty-three per cent of standard letter patients were satisfied with their mode of referral compared with 87% of direct access patients. Conclusions Given appropriate guidelines dental practitioners are able to refer directly to oral surgery day case operation lists. This has proved to be the favoured method of referral for dental practitioners, the secondary sector and patients.

关键词：门诊外科手术/统计学和数值数据医务工作者的态度牙科医院/统计学和数值数据开业医生牙科/组织和管理开业医生牙科/统计学和数值数据口腔外科手术/统计学和数值数据病人满意度随机分配转诊和会诊/组织和管理转诊和会诊/统计学和数值数据外科口腔/组织和管理青少年成年人人类中年人

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Effects of second office and hospital consulting practices of physicians on rural communities

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JOURNAL OF RURAL HEALTH 1997年第3期13卷 179-189页

作者： Hicks, LL Hassinger, E Taparanskas, W UNIV MISSOURI 324 CLARK HALLCOLUMBIAMO 65211 USA

This research examined the prevalence of second offices and hospital consulting practices of physicians in Missouri, the characteristics of physicians participating in such practices, the change in availability of services through these practices, the characteristics of counties and hospitals involved, and the practice organization of participating physicians. The assessment of the factors was conducted within the conceptual framework of community and physician characteristics, practice form and organization, and health system resources. In 1993, 64 of the 93 nonmetropolitan counties in Missouri, gained, on average, 1.3 full-time equivalent physicians through second office and hospital consulting practices. Eighteen nonmetropolitan counties lost, on average, 0.4 full-time equivalent physicians through these practices;11 nonmetropolitan counties were not affected. The majority of physicians engaged in these two types of practices are nonprimary care specialists. Consequently, in addition to the net contribution to total physician service availability, many nonmetropolitan counties gained access locally to a wider variety of specialty services. This change in availability of physician services, not generally incorporated in decisions, needs to be considered when policy efforts are undertaken to change the spatial and specialty distribution of physicians.

关键词：职业选择卫生保健调查/方法卫生服务易得程度卫生服务研究医院乡村/人力院内诊疗医务人员医院/供应和分配密苏里医师/统计学和数值数据医师/供应和分配医师办公室专业场所/统计学和数值数据转诊和会诊/组织和管理乡村卫生服务/人力女(雌)性人类男(雄)性

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Making the link - An impact evaluation of one Dublin hospital's accident & emergency department's liaison nurse service

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Accident and Emergency Nursing 2003年第1期11卷 39-48页

作者： McBride, Louise Kavanagh College of Nursing Mater Misericordiae Hospital Dublin 7 Ireland

The Accident & Emergency (A&E) liaison nurse service (LNS) was introduced at the Mater Misericordiae Hospital, Dublin as a quality improvement initiative in June 1996. It aimed to improve and enhance communication channels between the hospital and general practitioners (GPs) in the hospital's catchment area. A quantitative study was conducted to evaluate the A&E LNS, in partial fulfilment of a Master's degree in Nursing Science at the University of Dublin, Trinity College, Dublin. The primary users (90 GPs and 52 A&E staff, n=142) of the service were asked to complete a questionnaire comprising open and closed questions. Descriptive analysis using parametric and non-parametric tests was carried out, using the Statistical Package for the Social Sciences (SPSS version 9), on the collected data. Content analysis was used to analyse the open-ended questions. The findings of the study suggest that the A&E LNS positively affects communication between the hospital and GPs, and favourably affects the continuity and quality of patient care. The study respondents strongly supported the provision of an A&E LNS and expressed positive attitudes towards the quality of the service provided. This piece of research provides a basic understanding of the role, function and scope of practice of the A&E liaison nurse specialist. Implications for practice and areas for improvement are also outlined and identified. © 2003 Elsevier Science Ltd. All rights reserved.

关键词：信息交流病人医护连续性/组织和管理急诊室医院/标准家庭医学医院医生关系爱尔兰护理部医院卫生保健质量转诊和会诊/组织和管理统计学非参数全面质量管理人类

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Referral patterns and the referral system for oral surgery care. Part 2. The referral system and telemedicine

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BRITISH DENTAL JOURNAL 2000年第7期188卷 388-391页

作者： Coulthard, P Kazakou, I Koran, R Worthington, HV Univ Manchester Dent Hosp Manchester M15 6FH Lancs England

Objective To investigate GDP opinions of the current referral system and to investigate the need and demand for telemedicine in oral surgery referrals. Design Postal questionnaire. Setting 400 GDPs in Greater Manchester. Results 84% participation rate. 48% were not satisfied overall with the service of their current specialist oral surgery referral site. The principal reason was the length of the waiting time for consultation and treatment. Distance for patients to travel to the specialist unit was also of concern, even though most patients (89%) travelled short distances (return journey of twelve miles or less). 23% of respondents wished to improve their ability to communicate with the oral surgeon and 70% wanted involvement in the patient consultation. Both of these requirements were more likely in younger practitioners. Conclusion There is a need and demand for change in the referral system for oral surgery specialist care. Telemedicine could conceivably be one way to improve access to specialist oral surgery care.

关键词：医务工作者的态度信息交流英格兰开业医生牙科卫生服务易得程度卫生服务需求职业间关系口腔外科手术个人满足转诊和会诊/组织和管理远程会诊外科口腔时间因素预约名单成年人老年人女(雌)性人类男(雄)性中年人

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Post-take ward round in the department of medicine for the elderly

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JOURNAL OF THE ROYAL SOCIETY OF MEDICINE 1998年第11期91卷 612-612页

作者： Jolobe, OMP Tameside Gen Hosp Dept Med Elderly Ashton Under Lyne OL6 9RW England

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急诊患者院内交接单的设计与应用

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中国误诊学杂志 2011年第35期11卷 8702-8702页

作者：李香玉吉林省延边大学附属医院急诊科 133000

急诊科是抢救急危重症患者的场所，是医疗、护理工作的最前线。急诊工作的特点是病情紧急、不可预见性大、病谱广、医疗纠纷多。防范护理差错和事故，确保护理安全已成为现代护理管理工作的重点。危重患者的管理是医疗护理活动中重要一... 详细信息

急诊科是抢救急危重症患者的场所，是医疗、护理工作的最前线。急诊工作的特点是病情紧急、不可预见性大、病谱广、医疗纠纷多。防范护理差错和事故，确保护理安全已成为现代护理管理工作的重点。危重患者的管理是医疗护理活动中重要一项，而急危重患者的转运、检查环节是质量控制、减少纠纷的重要环节之一。我院从2008-01使用自行设计的急诊患者院内交接单．经过3a的临床应用，取得了良好的效果。

关键词：转诊和会诊/组织和管理

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