The Robustness and Effectiveness of the Triage System at Times of Overcrowding and the Extra Costs due to Inappropriate Use of Emergency Departments
The Robustness and Effectiveness of the Triage System at Times of Overcrowding and the Extra Costs due to Inappropriate Use of Emergency Departments
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DOI：
10.1007/s40258-015-0166-5
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发表时间：
2015-10-01
影响因子：
3.6
通讯作者：
Persico, Luca
中科院分区：
文献类型：
--
作者：
Cremonesi, Paolo;di Bella, Enrico;Persico, Luca
背景急诊室过度拥挤是急诊科（艾德）管理中最有害的问题之一，正确估计每种类型患者的时间资源吸收在处理过度拥挤和正确规划艾德活动中起着战略性作用。分流病人优先系统的鲁棒性），并评估由于不适当的使用EDs.Methods的54，254例患者谁访问的艾德的意大利一家大型医院在2011年的数据进行了分析，研究病人流量和过度拥挤的额外成本。为了确定平均每位患者的费用，根据他或她的健康状况的严重程度，上述医院的2010年的利润和亏损的帐户进行了研究，医生投入到每种类型的病人的时间估计通过自我报告survey.Results实证研究结果证实了过度拥挤和病人接受治疗前等待的时间之间的正相关性。这种影响只与非紧急病人有关，他们对过度拥挤本身负有责任。不过，紧急病人的轮候时间并没有因挤迫情况而增加，证明分流优先次序制度在挤迫情况下是稳健的。该分析使用2010年的数据估计，医院在治疗白码患者时，每位患者的实际成本平均为36.54欧元;绿色代码为93.17欧元，黄色代码为170.62欧元，红色代码为227.62欧元。它出现的所有人员成本的4%是由于白色彩色代码援助，67%的绿色代码，23%的黄色代码，其余的6%的红色代码。结论实施有效的政策，旨在提高效率和质量，在提供紧急卫生服务，必须处理的系统性问题，不适当地使用ED。决策者应意识到，艾德对援助的需求中有相当一部分是不适当的，相对于真正、适当、紧急的病人需求而言，过多的ED可能会导致不适当的援助需求进一步增加，从而增加与其目标不一致的艾德成本。
Background Overcrowding is one of the most harmful problems for Emergency Department (ED) management and the correct estimation of time resource absorption by each type of patient plays a strategic role in dealing with overcrowding and correctly programming ED activity.Objective We aimed to investigate how overcrowding may affect urgent patients' waiting times (i.e., the robustness of the triage patient priority system) and to evaluate the extra costs due to inappropriate use of EDs.Methods Data referring to 54,254 patients who accessed the ED of a major Italian hospital in 2011 were analyzed to study patient flows and overcrowding. To define an average per-patient cost, according to the severity of his or her health condition, the 2010 profit and loss account of the aforementioned hospital was studied and the time devoted by physicians to each type of patient was estimated by means of a self-reported survey.Results Empirical findings confirm a positive correlation between overcrowding and the time a patient has to wait before receiving treatment. This effect is relevant only for non-urgent patients who are responsible for the overcrowding itself. However, urgent patients' waiting times do not increase in the presence of overcrowding, confirming that the triage priority system is robust against the overcrowding situation. The analysis estimates, using 2010 data, that the actual per patient cost incurred by the hospital when treating white-coded patients is, on average, 36.54 euros; a green code costs 93.17, yellow 170.62, and red 227.62. It emerges that 4 % of all the personnel costs are attributable to white color-code assistance, 67 % to green codes, 23 % to yellow codes, and the remaining 6 % to red codes.Conclusion The implementation of effective policies intended to improve both efficiency and quality in providing emergency health services has to deal with the systemic problem of inappropriate use of EDs. Policy-makers should be aware of the fact that there is a considerable portion of ED demand for assistance that is inappropriate and that oversizing EDs with respect to the true, appropriate, urgent patients' demands, could bring about a further and undesirable rise in inappropriate assistance demands and, therefore, an increase in ED costs that are not consistent with their objectives.