Objectives-To determine (a) whether doctors involved in the process of emergency surgical admission could agree about which patients should be admitted, (b) whether there were consistent differences between doctors in different speciality groups, and (c) whether these opinions were greatly influenced by non-clinical factors.
Design-Independent assessment of summarised case histories by three « expert » clinicians (two consultant surgeons and one general practitioner (GP)), by a group of 10 GPs, and by a group of 10 junior and senior surgeons.
Experts, but not other observers, scored admissions both independently and as a consensus group.
Observers indicated for each patient whether they would admit, would not admit, or were unsure.
Setting-An urban general hospital with teaching status.
Subjects-Fifty consecutive patients admitted to the general surgical unit as emergencies during 1995.
Main outcome measures-Proportion of admissions considered unnecessary or uncertain : agreement between observers on these proportions : effect of social and procedural factors on the admission decision.
Between 8 and 34% of admissions were considered unnecessary and 20-38% of unclear necessity.
Agreement between the groups of clinicians was not good.
GPs and consultant surgeons showed the poorest agreement (kappa=0.08 to 0.25,4 comparisons), and the GPs scored a higher percentage of admissions as unnecessary (34 v 8-12%). (...)
Mots-clés Pascal : Admission hôpital, Service hospitalier, Urgence, Chirurgie, Attitude, Personnel sanitaire, Chirurgien, Médecin généraliste, Spécialité médicale, Etude comparative, Accord interjuge, Royaume Uni, Europe
Mots-clés Pascal anglais : Hospital admission, Hospital ward, Emergency, Surgery, Attitude, Health staff, Surgeon, General practitioner, Medical specialty, Comparative study, Interrater agreement, United Kingdom, Europe
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0402435
Code Inist : 002B30A05. Création : 19/12/1997.