응급 협의진료 질 평가를 위한 기초 연구

Abstract

Purpose: Emergency consultation is a common and important aspect in the emergency department (ED). Kessler et al. suggested the five Cs of the emergency medicine (EM) consulting checklist; contact, communication, core question, collaboration, and closing the loop as a tool for evaluation of consultation quality. The objective of this study was to evaluate the appropriateness of this checklist as a tool for assessment of the skill of requesting consultation in the ED. Methods: This study was conducted in the ED at an urban training hospital. Three emergency physicians recorded telephone conversations when they contacted consultant physicians for consultation regarding emergency patients. After recording files were collected, eight raters evaluated each conversation using the five Cs of the EM consulting checklist. Results: A total of 58 cases were gathered. The most frequent emergency acuity level of patients was 3, by 72.4%. The mean duration of conversation was 53±30 seconds. The mean total score was 41.9±3.1. When the scores for the five Cs` categories were evaluated, the score was lowest, at 2.9±1.0 for ``contact`` and highest, at 4.8±0.5, for ``communication``. Inter-rater agreement (95%confidence interval) of the total score was 0.819 (0.755-0.875). In the case of acuity level 3, the agreement was high, at 0.859(0.796-0.911), whereas it was 0.691 (0.491-0.874) and 0.426(0.115-0.922) in acuity levels 2 and 4, respectively. Conclusion: EM consultations were evaluated according to the five Cs of the EM consulting checklist showing high inter-rater agreement. This checklist could be used as a tool for monitoring and feedback in EM residency training.