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首页> 外文期刊>Iranian red crescent medical journal >Unscheduled Return Visits and Leaving the Chest Pain Unit Against Medical Advice
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Unscheduled Return Visits and Leaving the Chest Pain Unit Against Medical Advice

机译：计划外的回诊并让胸痛科接受医疗咨询

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摘要

Rate of Unscheduled Return Visits (URVs) to the Emergency Department has been considered as a key indicator for evaluating the quality of the Emergency Department care for decades. A higher rate of URVs can have a negative impact on the quality of health care. Investigations of the reasons for these returns have indicated that many of these visits can be preventable. Objectives: Given that there are no clear findings about the frequency and reasons for 72 hours URVs to the Chest Pain Unit (CPU), in the present study, we investigated the causes of 72 hours URVs to our CPU in order to find out the inadequacies, and propose preventive strategies. Patients and Methods: This research was a single-center retrospective case control study in the setting of CPU of Tehran Heart Center (a 460-bed, tertiary-care teaching hospital), Tehran, Iran. The medical records of the patients who were presented to our CPU with the chief complaint of chest pain between December 28th, 2010 and February 28th, 2011 were reviewed. Of the 6247 eligible patients, forty-nine URVs that fulfilled our criteria were identified. The control group consisted of 196 patients who did not return to the Emergency Department during our study period. Results: Patient-related factors accounted for most 72 hours URVs (49%). Multivariable analysis revealed that in our CPU, leaving Against medical advice was the most important predictor for 72 hours URVs (P value < 0.001). Additionally, male sex, history of hypertension, first-visit disposition to observation unit and age were the other factors associated with URVs. Conclusions: Considering that the most frequent reason for our URVs was patient-related factors, where all cases had left the CPU Against Medical Advice (AMA) during their first attendance, we recommend that further appropriate strategies be devised to prevent leaving against medical advice.
机译：几十年来，急诊部的计划外回诊率一直被视为评估急诊部护理质量的关键指标。较高的URV数量可能会对医疗保健质量产生负面影响。对这些返回原因的调查表明，许多此类访问是可以预防的。目的：鉴于尚无明确的发现72个小时URV发生于胸痛病房（CPU）的频率和原因，在本研究中，我们调查了72个小时URV发生于CPU的原因，以找出不足之处。 ，并提出预防策略。患者与方法：这项研究是在伊朗德黑兰德黑兰心脏中心（拥有460张床的三级护理教学医院）的CPU中心进行的单中心回顾性病例对照研究。我们回顾了2010年12月28日至2011年2月28日之间因胸痛而主诉到我们CPU的患者的病历。在6247名合格患者中，确定了满足我们标准的49例URV。对照组包括196名在我们的研究期间未返回急诊科的患者。结果：与患者相关的因素占大多数72小时URV（49％）。多变量分析显示，在我们的CPU中，不遵医嘱是72小时URV的最重要预测因素（P值<0.001）。此外，男性，高血压病史，对观察单位的首次就诊倾向和年龄是与URV相关的其他因素。结论：考虑到我们的URV的最常见原因是与患者相关的因素，所有病例在首次就诊时都离开了CPU反对医学咨询（AMA），因此，我们建议设计进一步的适当策略以防止偏离医学咨询。

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