传统的石头诊所是否是NHS资源的最佳使用方式?
Joel Corkill1, Adrian Sale2, Christopher Gallegos2
1Royal United Hospital Bath NHS Trust (JC, CG, EJ), Swansea Bay University Health Board NHS Trust (AS), Bath, UK. j.corkill@nhs.net.
Urolithiasis
|February 1, 2024
概括
传统的石头后续可能不有效. 一项研究发现,大多数需要干预的患者有症状,这表明直接访问的紧急石头诊所可以改善护理和资源.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 腎臟病學 (nephrology) 是一種醫學專業.
- 医疗保健管理的管理
背景情况:
- 目前的证据缺乏明确的指导,对传统的石头后续协议的有效性.
- 国家卫生和护理卓越研究所 (NICE) 由于公布的数据不足,无法提出建议.
- 了解导致结石手术的患者旅程至关重要.
研究的目的:
- 评估在接受外科手术的患者中传统石头随访的有效性.
- 分析患者从初始呈现到对结石进行手术的旅程.
- 评估当前后续策略对资源利用和患者治疗结果的影响.
主要方法:
- 在三年内对471名接受尿路透镜检查 (URS) 或皮肤穿神经切除术 (PCNL) 的患者进行了回顾性审查.
- 分析患者记录,包括症状,预订机制,干预原因,石头特征,风险因素和先前跟踪.
- 在不同患者途径之间比较干预率,败血症率和门诊成像频率.
主要成果:
- 36%的接受干预的患者最初通过石头诊所的随访进行了管理.
- 从石头诊所随访预约的96%的患者有症状;当排除风险因素时,这一比例降至1%.
- 紧急住院的败血症率为随访患者的13%,而新出现的患者为19%,在成像频率上没有显著差异.
结论:
- 传统的石头随访可能会导致对低比例的无症状患者进行干预,这表明潜在的效率低下.
- 一个有症状的,直接访问的紧急石头诊所模型可能是更有效地利用国家卫生服务 (NHS) 的资源.
- 需要进一步的紧急研究来验证结石管理的替代护理模式.
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