Télécharger le rapport (152 p.) - KCE

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104 Urgences KCE reports vol. 19B AUTHOR, YEAR COUNTRY LEE A. ET AL, 2003 HONG KONG LEIBOWITZ R ET AL. 2003 AUSTRALIA LEUNG GM ET AL, 2001 HONG KONG MARTIN BC, 2000 USA STUDY DESIGN Cross-sectional Validation SAMPLE SETTING 1 year randomly selected patients of A&E review Original studies and systematic review since 1976 Cross-sectional Conjoint analysis 390 semi-urgent or non-urgent patients 3 Eds Cross-sectional Data from clinical records, financial comparative analyses (3 non-emergent diagnosis) RESULT / CONCLUSION The most accurate unweighted nurses' triage classification had an average sensitivity of 87.8%, specificity of 83.9%, and a PPV of 70.1%. When weighted, the average sensitivity reduced to 75%, specificity to 65.7%, and PPV to 54%. The most accurate unweighted patients' self-triage classification yielded a sensitivity of 62.5%, specificity of 69.2%, and a PPV of 58.1%, and correspondingly reduced to 43.3, 49.2 and 38.6% if weights were applied. If a mechanism was put in place for additional screening on visitors with a borderline semi-urgent or non-urgent status, the nurses could safely reassign non-urgent patients to GP care. The rapid growth in telephone triage and advice services appears to have the advantage of reducing immediate medical workload through the substitution of telephone consultations for in-person consultations, and this has the potential to reduce costs. However, this has to be balanced with the finding of reduced patient satisfaction when in-person consultations are replaced by telephone consultations. The relative importance attached to illness severity, waiting time, and consultation fee were 47.8%, 33.6%, and 18.7%, respectively. Hong Kong patients are receptive to the concept of parallel clinics. Conjoint analysis is a rigorous survey technique for eliciting the views of patients on health care services in the ED setting. Total cost higher in the ED due primarily to differences in ancillary tests and prescription
KCE reports vol. 19B Urgences 105 AUTHOR, YEAR COUNTRY OLSHAKER JS, 1999 USA SCHNEIDER S. 2001 USA STUDY DESIGN SAMPLE SETTING RESULT / CONCLUSION Cross-sectional 100 patients randomly on 6 days Non-compliance, with drug prescriptions (mainly phenytoin and albuterol) is a significant contributor to ED visits and health care costs Descriptive study Strategies that had little effect on ED overcrowding were based from the ED, such as ambulance diversion. Successful: those that addressed factors external to the ED such as increased flexibility of inpatient resources; float nurses who responded to acute care needs; a transition team (mid-level provider along with registered nurse (RN)/licensed practical nurse) who cared for inpatients boarded in the ED; integrated services across affiliated hospitals/systems; an early alert system that notified key personnel before "code red" criteria were met; and a multidisciplinary team to round in the ED and analyze resource needs. Current community-wide initiatives include precise tracking of code red hours; monitoring patient length of stay (LOS) in the ED and inpatient units; education of physicians and nursing homes regarding ED alternatives; exploration of additional resources for sub acute and long-term care; establishing a regional forum to address the nursing shortage; development of an ED triage system to coordinate diversion activities during code red; and consideration of a countywide state of emergency when needed. CONCLUSIONS: Emergency department overcrowding is the end result of a variety of factors that must be addressed system-wide
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