英格兰数字支持的初级和二级急诊电话分拣的安全性和准确性:使用例行数据的观察性研究
Vanashree Sexton1, Catherine Grimley2, Jeremy Dale2
1Warwick Medical School, University of Warwick, Coventry, UK. ash.v.s.sexton@warwick.ac.uk.
BMC medical informatics and decision making
|February 3, 2025
概括
临床医生领导的紧急护理分拣比非临床医生分拣更准确,用于确定需要紧急或住院护理的需求. 需要对不足选因素进行进一步的调查,以提高系统的安全性和有效性.
科学领域:
- 医疗保健系统分析 医疗保健系统分析
- 紧急医疗 紧急医疗
- 鉴定准确度 鉴定准确度 鉴定准确度
背景情况:
- 英格兰的紧急护理系统使用非临床医生初级分拣 (NHS111) 和临床医生领导的二级分拣.
- 在两阶段都使用了数字决策支持工具.
- 该研究评估了该系统在24小时内对急诊室 (ED) 和住院患者的入院的安全性和准确性.
研究的目的:
- 为了比较非临床医生主导的初级分拣与临床医生主导的二级分拣的安全性和准确性.
- 评估系统在预测急诊室或住院护理需求方面的表现.
- 确定导致紧急护理电话系统潜在低分辨率的因素.
主要方法:
- 对98,946个正在接受初级和二级分拣的电话进行描述性分析.
- 敏感性 (安全性) 和特异性 (准确性) 的调查与随后的急救服务和住院住院相关.
- 混合效应回归模型,以探索潜在的临床风险低估 (低位).
主要成果:
- 与初级分组 (20.7%的ED,9.2%的入院患者) 相比,二级分组显示出更高的特异性 (46.0%的ED,18.0%的住院患者).
- 在第二次分拣中,有1.5%的患者被分拣为当天或不那么紧急的患者被录取.
- 诸如呼叫时间 (午夜至凌晨6点),呼叫时间,服务提供商和个人临床医生等因素显著影响了潜在的不足选.
结论:
- 临床医生主导的二次分组比非临床医生主导的初级分组更准确地预测需要ED或住院护理.
- 非临床医生初级分组具有高灵敏度但低特异性,表明风险偏向的方法.
- 调查与低分辨率相关的服务和临床医生特征对于提高紧急护理电话分辨率安全性和有效性至关重要.
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