RESUMO
At a time when «â Smarter medicineâ ¼ and «â Choosing Wiselyâ ¼ campains become increasingly important, emergency medicine is no exception. Many recent studies lead us to reconsider our practices and to change our work-up and treatement strategies, to ultimately use only the ones with a real clinical benefit for emergency departement patients.
À l'heure où le concept de smarter medicine s'applique de plus en plus à la pratique médicale, la médecine d'urgence ne fait pas exception et de nombreux travaux récents nous amènent à revoir nos pratiques, à changer nos stratégies de prise en charge pour finalement ne retenir que les examens ou traitements ayant un réel bénéfice pour les patients en situation d'urgence.
Assuntos
Medicina de Emergência , Medicina de Emergência/tendências , Serviço Hospitalar de Emergência , HumanosRESUMO
BACKGROUND: Laboratory and radiographic tests are often repeated during inter-hospital transfers from secondary to tertiary emergency departments (ED), despite available data from the sending structure. The aim of this study was to identify the proportion of repeated tests in patients transferred to a tertiary care ED, and to estimate their inappropriateness and their costs. METHODS: A retrospective chart review of all adult patients transferred from one secondary care ED to a tertiary care ED during the year 2016 was carried out. The primary outcome was the redundancy (proportion of procedure repeated in the 8 h following the transfer, despite the availability of the previous results). Factors predicting the repetition of procedures were identified through a logistic regression analysis. Two authors independently assessed inappropriateness. RESULTS: In 2016, 432 patients were transferred from the secondary to the tertiary ED, and 251 procedures were repeated: 179 patients (77.2%) had a repeated laboratory test, 34 (14.7%) a repeated radiological procedure and 19 (8.2%) both. Repeated procedures were judged as inappropriate for 197 (99.5%) laboratory tests and for 39 (73.6%) radiological procedures. CONCLUSION: Over half of the patients transferred from another emergency department had a repeated procedure. In most cases, these repeated procedures were considered inappropriate.