Publication: Muayene edildikten sonra tıbbi uyarılara rağmen acil servisi terk eden hastaların değerlendirilmesi
Abstract
G i r i ş: Acil serviste muayene olduktan sonra tıbbi tavsiyelere rağmen herhangi bir tedavi almadan ya da tedavileri tamamlanmadan terk eden durumu ciddi hastalar, hem kendilerine hem de hekimlerine sorumluluk yüklemektedir. Bu çalışmanın amacı tıbbi tavsiyelere rağmen acil servisten ayrılan hastaların genel özelliklerini belirlemek, ayrılma nedenleri ve aciliyetlerini incelemektir. Gereç ve Yöntem: Aralık 2006-Mart 2007 tarihleri arasında Marmara Üniversitesi Hastanesi Acil Servisine başvuran, kendi yazılı onayı ile acil servisten ayrılan 18 yaş üzerindeki hastalar geriye dönük olarak çalışmaya alındı. Çalışma verileri bilgisayarlı veri tabanından elde edildi. Genel karakteristik özellikler, The Canadian Emergency Department Triage and Acuity Scale’ya göre hastalığın ağırlığı ve acil serviste kalış süreleri not edildi. Hastaların ayrılmadan önce imzaladıkları formlardan ayrılma nedenleri belirlendi. Bulgular: Çalışmaya toplam 97 hasta alındı. Tıbbi tavsiyelere rağmen, bir hekim tarafından muayene edildikten sonra acili terk eden hastalar, aynı dönemde acil servise başvuruların %3,3’ünü oluşturmaktadır. Hastaların %54’ü “acil” olarak değerlendirildi. Ortalama yaş 48,6±12,5 ve %49’u erkekti. Acil serviste kalış süresi ortalama 138±130 dakikaydı. Acil servisi terk etmenin en sık nedenleri Acil Grubunda “müşahadeyi kabul etmeme” (%31, n=15), Acil Olmayan Grupta ise “müdahale ve tedaviyi kabul etmeme” (%39, n=20) olarak bulundu. Sonuç: Hastaların acil servisten ayrılma nedenlerinin belirlenmesi, bu konuda çözüm yollarının bulunmasına katkıda bulunabilir.
Objectives: Patients with serious illnesses who leave emergency department (ED) without being treated or insufficiently treated burden both physicians and themselves. The aim of this study was to evaluate general characteristics of patients who leave ED against medical advice and to determine the causes and severity of their illnesses. Materials and Methods: A retrospective chart was performed covering December 2006 to March 2007 including patients who were elder than 18 years and discharged with their own consent from the ED. The data were obtained from computerized database. The general characteristics of patients, severity of their illnesses according to The Canadian Emergency Department Triage and Acuity Scale (CTAS), and length of ED stay were recorded. The causes of leaving ED were determined from the discharge consent forms filled by patients before leaving ED. Results: A total of 97 patients were included into the study. The patients who left the ED against medical advice after being examined by a physician composed 3.3% of all emergency cases. 54% of the patients were triaged as ‘urgent’. The mean age of the study patients was 48.6±12.5 years and 49% were male. Mean length of ED stay was 138±130 minutes. The most common reason for leaving hospital among patients with triaged as urgent was “refuse hospital admission or ED observation” and “refuse the treatment regimen” was the most common reason in non-urgent group. Conclusion: Determining the causes of leaving ED against medical advises should contribute finding solutions to this issue.
Objectives: Patients with serious illnesses who leave emergency department (ED) without being treated or insufficiently treated burden both physicians and themselves. The aim of this study was to evaluate general characteristics of patients who leave ED against medical advice and to determine the causes and severity of their illnesses. Materials and Methods: A retrospective chart was performed covering December 2006 to March 2007 including patients who were elder than 18 years and discharged with their own consent from the ED. The data were obtained from computerized database. The general characteristics of patients, severity of their illnesses according to The Canadian Emergency Department Triage and Acuity Scale (CTAS), and length of ED stay were recorded. The causes of leaving ED were determined from the discharge consent forms filled by patients before leaving ED. Results: A total of 97 patients were included into the study. The patients who left the ED against medical advice after being examined by a physician composed 3.3% of all emergency cases. 54% of the patients were triaged as ‘urgent’. The mean age of the study patients was 48.6±12.5 years and 49% were male. Mean length of ED stay was 138±130 minutes. The most common reason for leaving hospital among patients with triaged as urgent was “refuse hospital admission or ED observation” and “refuse the treatment regimen” was the most common reason in non-urgent group. Conclusion: Determining the causes of leaving ED against medical advises should contribute finding solutions to this issue.