Crowding Delays Treatment and Lengthens Emergency Department Length of Stay, Even Among High-Acuity Patients
Crowding Delays Treatment and Lengthens Emergency Department Length of Stay, Even Among High-Acuity Patients
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DOI：
10.1016/j.annemergmed.2009.03.006
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发表时间：
2009-10-01
影响因子：
6.2
通讯作者：
Aronsky, Dominik
中科院分区：
文献类型：
--
作者：
McCarthy, Melissa L.;Zeger, Scott L.;Aronsky, Dominik
研究目的：研究拥挤对急诊科候诊室、治疗和登机时间的影响。方法：这是一项回溯性队列研究，包括4个急诊室1年的急诊室就诊和住院药物占用数据。我们测量了每个患者在急诊室住院期间每隔30分钟的拥挤情况。我们分别估计了拥挤对候诊室时间、治疗时间和登机时间的影响，并控制了患者的人口学和临床特征，采用离散时间生存分析方法(即等待人数、待治疗人数、登机人数和住院药物占有率)。结果：拥挤显著延迟了患者的候诊室和登机时间，但不影响治疗时间。在白班期间，当登车人数由第50百分位数增加至第90百分位数时，经调整的轮候时间中位数(26至70分钟)增加6%至78%(33至82分钟)，而经调整的中位数登车时间(250至626分钟)增加15%至47%(288至921分钟)，视乎地点而定。拥挤推迟了所有地点高视力2级患者的护理。在拥挤时段(即90%)，高视力2级患者调整后的中位候诊室时间比正常时段高3%至35%，这取决于地点和拥挤程度。结论：使用离散时间生存分析，我们能够动态测量每个患者急诊期间的拥挤程度，并展示其对急救及时性的有害影响，即使对高视力患者也是如此。访问数/每百万人：Reach for[Ann Emerg2009；54：492-503。]
Study objective: We determine the effect of crowding on emergency department (ED) waiting room, treatment, and boarding times across multiple sites and acuity groups.Methods: This was a retrospective cohort study that included ED visit and inpatient medicine occupancy data for a 1-year period at 4 EDs. We measured crowding at 30-minute intervals throughout each patient's ED stay. We estimated the effect of crowding on waiting room time, treatment time, and boarding time separately, using discrete-time survival analysis with time-dependent crowding measures (ie, number waiting, number being treated, number boarding, and inpatient medicine occupancy rate), controlling for patient demographic and clinical characteristics.Results: Crowding substantially delayed patients' waiting room and boarding times but not treatment time. During the day shift, when the number boarding increased from the 50th to the 90th percentile, the adjusted median waiting room time (range 26 to 70 minutes) increased by 6% to 78% (range 33 to 82 minutes), and the adjusted median boarding time (range 250 to 626 minutes) increased by 15% to 47% (range 288 to 921 minutes), depending on the site. Crowding delayed the care of high-acuity level 2 patients at all sites. During crowded periods (ie, 90%), the adjusted median waiting room times of high-acuity level 2 patients were 3% to 35% higher than during normal periods, depending on the site and crowding measure.Conclusion: Using discrete-time survival analysis, we were able to dynamically measure crowding throughout each patient's ED visit and demonstrate its deleterious effect on the timeliness of emergency care, even for high-acuity patients. [Ann Emerg Med. 2009;54:492-503.]