ED crowding is associated with variable perceptions of care compromise
ED crowding is associated with variable perceptions of care compromise
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DOI：
10.1197/j.aem.2007.06.043
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发表时间：
2007-12-01
影响因子：
4.4
通讯作者：
Hollander, Judd E.
中科院分区：
文献类型：
--
作者：
Pines, Jesse M.;Garson, Chad;Hollander, Judd E.
目的：作者测量了急诊科（ED）拥挤与患者和提供者对患者护理是否受到损害的看法之间的关系。方法：这是一项对急诊科收治的患者及其提供者的横断面研究。对病人、护士和住院医师的调查是相互关联的。主要结果是在评估急诊科拥挤是否影响护理的五项量表上达成一致或非常一致。使用逻辑回归来确定主要结局与ED拥挤测量之间的关系。结果：在741例患者中，644例患者同意（87%）；共完成住院医师调查703份（95%）和护理调查716份（97%）。共有106名患者（16%）、86名住院医师（12%）和173名护士（24%）报告说，急诊拥挤影响了护理。在252例（35%）中，一个或多个应答者报告说护理受到了损害。对于谁的护理受到损害，各方意见不一。对于患者来说，影响护理的独立预测因素是候诊室时间（比值比[OR]，每增加10分钟等待1.05[95%可信区间{CI} = 1.02至1.09]）和在走廊床接受调查（比值比[OR]， 2.02 [95% CI = 1.12至3.681）。护士护理受损的预测因子包括候诊室时间（OR，每增加10分钟等待1.05 [95% CI = 1.01至1.08]）、候诊室患者数量（OR，每增加10分钟等待1.05 [95% CI = 1.02至1.07]）和住院患者数量（OR，每增加1名患者等待1.08 [95% CI = 1.03至1.12]）。对于住院医师，患者/护士比率（OR，每增加一个单位1.39 [95% CI = 1.09至1.20]）和住院等待患者数量（OR，每增加一个患者1.14 [95% Cl = 1.10至1.75]）是护理受损的预测因子。结论：急诊科拥挤与人们对急诊护理受损的认知有关。护士、患者和住院医师在哪些因素与不良护理相关、谁的护理受到不良影响以及如何受到不良影响方面存在相当大的差异。
Objectives: The authors measured the association between emergency department (ED) crowding and patient and provider perceptions about whether patient care was compromised.Methods: This was a cross-sectional study of patients admitted from the ED and their providers. Surveys of patients, nurses, and resident physicians were linked. The primary outcome was agreement or strong agreement on a five-item scale assessing whether ED crowding compromised care. Logistic regression was used to determine the association between the primary outcome and measures of ED crowding.Results: Of 741 patients approached, 644 patients consented (87%); 703 resident physician surveys (95%) and 716 nursing surveys (97%) were completed. A total of 106 patients (16%), 86 residents (12%), and 173 nurses (24%) reported that care was compromised by ED crowding. In 252 cases (35%), one or more respondents reported that care was compromised. There was poor agreement over whose care was compromised. For patients, independent predictors of compromised care were waiting room time (odds ratio [OR], 1.05 for each additional 10-minute wait [95% confidence interval {CI} = 1.02 to 1.09]) and being surveyed in a hallway bed (OR, 2.02 [95% CI = 1.12 to 3.681). Predictors of compromised care for nurses included waiting room time (OR, 1.05 for each additional 10-minute wait [95% CI = 1.01 to 1.08]), number of patients in the waiting room (OR, 1.05 for each additional patient waiting [95% CI = 1.02 to 1.07]), and number of admitted patients waiting for an inpatient bed (OR, 1.08 for each additional patient [95% CI = 1.03 to 1.12]). For residents, predictors of compromised care were patient/nurse ratio (OR, 1.39 for a one-unit increase [95% CI = 1.09 to 1.20]) and number of admitted patients waiting for an inpatient bed (OR, 1.14 for each additional patient [95% Cl = 1.10 to 1.75]).Conclusions: ED crowding is associated with perceptions of compromised emergency care. There is considerable variability among nurses, patients, and resident physicians over which factors are associated with compromised care, whose care was compromised, and how care was compromised.