急诊患方自评紧急程度与医学评估的比较研究

A Comparative Study of Emergency Degree and Medical Assessment of Emergency Patient Self-assessment

目的比较急诊患方自评与医学评估患者病情紧急程度的差异。方法前瞻性纳入2017年12月—2018年1月8:00~9:00期间就诊于四川大学华西医院急诊科的患者,采用自行设计的问卷调查表收集患方基本信息及患方自评紧急程度,同时记录分诊护士对患者的分级情况;通过卡方检验比较患方自评与医学评估患者病情的紧急程度。进一步根据患方年龄、性别、学历、职业、患者发病时间及诊断类型进行分层,比较患方自评紧急程度与医学评估紧急程度的差异。结果患方自评其紧急程度1级、2级、3级、4级比例分别为0.32、0.61、0.05和0.01,高于医学评估的各级比例(0.01、0.15、0.83和0.02,P=0.000);不同年龄、性别、学历、职业及发病时间的患方自评紧急程度差异无统计学意义(P>0.05);不同诊断的患方自评紧急程度差异有统计学意义(P=0.043)。结论不同年龄、性别、学历、职业患方和医学评估对其急诊就诊的紧急程度的评估存在差异,患方对其紧急程度评估客观性较强,表明公众对急诊分诊制度的了解不够。应加大宣传力度及覆盖面,让公众理解并支持急诊分级分流的做法,最终改善急诊拥堵现状及医疗资源合理分配。

Objective To compare the difference of emergency degree between patient self-assessment and medical assessment.Methods Prospectively included patients who visited the emergency department of West China Hospital of Sichuan University from December 2017 to January 2018 from 8:00 to 9:00.Self-designed questionnaires were used to collect patient basic information and self-assessment emergency degree,and the grading of patients by triage nurses was recorded.The emergency degree of patients'self-assessment and medical assessment were compared by chisquare test.Further stratification was made according to age,sex,education,occupation,time of onset and type of diagnosis,and the difference between self-assessment and medical assessment was compared.Results The proportion of patient self-assessment of emergency level 1,2,3 and 4 was 0.32,0.61,0.05 and 0.01,respectively,higher than that of medical assessment of 0.01,0.15,0.83 and 0.02(P=0.000);there was no significant difference in self-assessment of emergency degree among patients of different ages,gender,educational background,occupation and time of onset(P>0.05);there was significant difference in self-assessment of emergency degree among patients with different diagnosis(P=0.043).Conclusion there are differences in the evaluation of emergency degree among patients of different age,gender,education background,occupation and medical evaluation.and patients with high objectivity in the evaluation of emergency degree.It shows that the public awareness of emergency triage system is not enough,so we should increase the publicity and coverage,so that the public can understand and support our practice of triage patients by classification and division,and finally improve the current situation of emergency congestion and reasonable allocation of medical resources through triage.