做好推荐– 感应

作者: 托马斯·威尔斯/ 编辑: Charlotte Davies / 问题: 克里斯·康诺利/ 代码: CC15,CC8 / 发布时间: 31/07/2018

我可以吗…ummm…refer…umm…52岁,55岁,55岁,69岁的女士出现胸痛。好吧,她说那是胸痛,但是’实际上是一种奇怪的紧绷感,并带有一些上腹痛。上星期二她在花园里浇水的时候就开始了。她弯下腰,痛苦开始了。所以她喝了一杯茶。嗯而且它仍然没有’t go. She’没有医学问题,但偶尔服用GTN喷雾剂和阿司匹林。我没’t sure what was going 上 , so thought it was safest to 参考 to you. But she doesn’不想进来是因为她’有两只猫-罂粟和种子-今晚需要喂食。

听起来有点熟?我们’d like not to 参考 patients like this, but unfortunately we all do! Making a 参考ral is a fundamental skill that we are required to have in order to provide safe care to patients in our EDs. Despite this, I was never formally taught how to do this during any ED induction programmes during my training. I can recall making unclear and poorly communicated 参考rals as a result. Having overheard many 参考rals made by others in our ED I know that I was not alone in feeling underprepared as a trainee, and that this is an art that we all need to develop as ED doctors.

In the first few weeks of your first ED placement, there is a steep learning curve as you work out which patients need to be 参考red, which specialty to 参考 them to, how the 参考ral pathways work in your ED and how to articulate your 参考rals in order to make the process run smoothly. In this blog, I shall try to describe some lessons that I have learnt from trial and error over the last fifteen years. It is based 上 personal experience and is by no means definitive. I encourage you to check out all the 参考ences listed at the end.

The first thing to consider is why we make 参考rals from the ED. Here are the main circumstances in which I think that we make 参考rals:

  1. 专业有我们所不具备的技能’没有(例如外科手术或影像学检查)
  2. 专业拥有我们所不具备的知识或经验’没有(例如急诊部初次管理/复苏后对急性病的持续护理)
  3. 专业可以访问我们提供的资源’没有(例如病房的床位供患者接受几天的静脉内治疗)

如果其他患病患者的敏锐度意味着我们无法提供一名EM医生来执行该技术,那么在极少数情况下,我们可能会要求专科医生执行在ED中可以执行的技能。这可能发生在早上的清晨,当时只有一名EM HST或中年级与更多的下级同事一起工作。

您很少需要聘请专业同事来征询患者管理方面的建议。所有建议最初应由您在急诊室的高级同事提供(他们将具有丰富的知识,不太可能不能由他们提供您所需要的建议)。但是,如果他们不知道您问题的答案,他们可能会建议您与其他专业交谈。

The other issue to be aware of is that the person receiving the phone call is likely to already have a large amount of work to do, and the last thing they may want when they speak to you is to have another 参考ral 查看. This is no excuse for them being rude or obstructive but we should be aware that we are not the 上 ly specialty in which demands upon us are extensive.

So here are some tips which I think will help you make excellent 参考rals:

  1. Always be polite. This should go without saying and should be maintained even if we believe the person we are 参考ring to is being unhelpful.
  2. 给病人’在介绍临床特征之前先给他们起个名字。我相信一旦他们写下患者姓名,“to see”清单,从心理上讲,他们已经开始对该患者承担一些所有权’的照顾,这似乎可以使过程顺利一些。
  3. Summarise the history and examination findings succinctly and leave in 上 ly the features that are relevant. It may be worth preparing what you are going to say by writing up your clinical notes before you make the 参考ral.
  4. If you ask a senior EM colleague for advice and they tell you to 参考 the patient 上 to a specialty but you do not fully understand why you have been asked to make that 参考ral, politely ask your colleague to explain to you exactly what you need from that receiving specialty. If you are 参考ring a patient who has been reviewed by 上 e of your consultants or seniors, explain this to the person receiving the 参考ral.
  5. Be explicit about what you expect of the person that you are 参考ring to. If you 上 ly require advice say so, if you want them 查看 the patient make that clear to them.
  6. Acknowledge that the person to whom you are 参考ring may have lots of other things to do. I often start my 参考rals by saying something like “I’m afraid that I have another 参考ral for you 查看”.
  7. Consider if there are things that you can do that will benefit the patient 上 behalf of the specialty you are 参考ring to. This may include investigations. You could offer to organise for them to have been performed before they see the patient.
  8. 在某些情况下,您会要求同事核实或执行您通过医院要求的程序或调查’电子系统(例如CT或内窥镜检查)。在这种情况下,最好说您已请求调查/程序,而不是‘ordered’ it.
  9. 确保你不’不要对患者做出任何承诺,以期望接受专科医师会做什么(除非您完全确定会发生什么)。如果未达到期望,这将减少以后投诉的可能性。
  10. Do not allow the person receiving the 参考ral to tell you to do something (e.g. send the patient home) if you are not comfortable with it. Find a senior colleague and discuss what you have been advised.
  11. Do not get into any arguments with a specialty colleague. If they decline 查看 the patient you are 参考ring to them and you cannot persuade them otherwise, politely end the conversation and discuss with your senior EM colleague (ideally a consultant). It may be that the person you are 参考ring to is correct, if not, any further discussions with them should be made by your boss.
  12. 以后跟进患者并跟踪他们的临床过程。电子笔记使这一过程变得更加容易,并使我们能够在与患者联系急诊室后的几小时,几天和几周内检查我们的印象和决策是否正确。

要进一步阅读,请查看以下资源:

圣埃姆林斯: Making a 参考ral with Iain Beardsell

Fastlane中的生活: 从急诊科转诊患者

急诊医学的学术生活:MEDIC:难诊案例 专家和社区回应

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2条留言

  1. 伊克巴利 说:

    感应包和iBook很棒
    我总是向新手推荐他们

  2. 谢丽尔·安·巴恩斯夫人 说:

    有用的感谢

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