Entry overload, emergency department overcrowding, and ambulance bypass
Entry overload, emergency department overcrowding, and ambulance bypass
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DOI：
10.1136/emj.20.5.406
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发表时间：
2003-09-01
影响因子：
3.1
通讯作者：
Hirsch, RL
中科院分区：
文献类型：
--
作者：
Fatovich, DM;Hirsch, RL
目的：描述急诊科（艾德）过度拥挤和救护车bypass.Methods的经验：在皇家珀斯医院，一个主要的教学医院的前瞻性观察研究。结果：1999年7月1日至2001年6月30日，共施行141次体外循环，平均时间187 min，范围35-995 min。周一是最常见的一天，有39次（28%）发作。单纯入口阻滞是旁路激活的最常见原因（n = 38，30.4%）。在这些时间，艾德的平均患者人数为40人（占用率为174%），其中9人在走廊，7人等待入院，14人等待就诊。归因于传入阻滞的癫痫发作通常发生在发病率大于或等于10例患者/小时，持续大于或等于2小时（OR 6.2，95%CI 4.3 - 8.5）。下午到傍晚是最常见的激活时间。救护车旁路增加的频率和duration.Conclusions：入口超载导致入口阻滞的结果，从压倒性的数量的患者提出的艾德在很短的时间内。入口阻挡妨碍获得紧急护理。除非在不久的将来采取措施，否则公众可能无法再依赖急诊室提供优质和及时的紧急护理。要解决这个问题，必须采取“全系统”的办法。
Objectives: To describe an experience of emergency department (ED) overcrowding and ambulance bypass.Methods: A prospective observational study at Royal Perth Hospital, a major teaching hospital. Episodes of ambulance bypass and their characteristics were recorded.Results: From 1 July 1999 to 30 June 2001, there were 141 episodes of ambulance bypass (mean duration 187 min, range 35-995). Monday was the most common day with 39 (28%) episodes. Entry block alone was the most common reason bypass was activated (n = 38, 30.4%). The mean number of patients in ED at these times was 40 (occupancy 174%), including nine in the corridor, seven awaiting admission, and 14 waiting to be seen. Episodes attributable to entry block were typically preceded by a presentation rate of greater than or equal to10 patients per hour for greater than or equal to2 hours (OR 6.2, 95% CI 4.3 to 8.5). Mid-afternoon to early evening was the most common time for activation. Ambulance bypass is increasing in frequency and duration.Conclusions: Entry overload resulting in entry block results from overwhelming numbers of patients presenting to the ED in a short space of time. Entry block impairs access to emergency care. Unless something is done in the near future, the general public may no longer be able to rely on EDs for quality and timely emergency care. A "whole of system" approach is necessary to tackle the problem.