The impact of consultation on length of stay in tertiary care emergency departments
The impact of consultation on length of stay in tertiary care emergency departments
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DOI：
10.1136/emermed-2012-201908
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发表时间：
2014-02-01
影响因子：
3.1
通讯作者：
Rowe, Brian H.
中科院分区：
文献类型：
--
作者：
Brick, Craig;Lowes, Justin;Rowe, Brian H.
背景急诊科(ED)的咨询很少被研究。这项研究量化了会诊对急诊住院时间(LOS)的贡献，并检查了患者和会诊特征与延长的ED LOS相关。方法前瞻性队列研究两个城市三级护理加拿大急诊室的志愿急诊医生(EP)的轮班便利样本。EPS填写了所有被要求咨询的患者的标准化表格。还进行了病历审查和行政数据库的二次分析。结果1180名患者在研究轮班期间至少接受了一次咨询，其中841名(71%)的EPS完成了数据收集。患者的平均年龄为54 岁，其中53.3%为男性，2.9%有记录的痴呆症。与出院患者相比，接受会诊的入院患者总体LOS时间更长。从分诊到会诊请求的中位时间在入院患者中约占总中位LOS的28%，而出院患者中这一比例为46%。就诊决策时间分别占入院和出院患者就诊决策时间的33%和54%。线性回归模型显示，高龄、到达和第一次会诊之间的潜伏期较长、痴呆症病史和多次会诊与较长的LOS显著相关。相反，在急诊室中进行手术与较短的LOS有关。结论咨询决策时间对ED LOS有显著影响。还需要进一步努力在其他ED设置中验证这些结果，并提高ED吞吐量的这一方面。
BackgroundConsultations in the emergency department (ED) are infrequently studied. This study quantifies the contribution of consultations to ED length of stay (LOS) and examines patient and consultation characteristics associated with prolonged ED LOS.MethodsProspective cohort study of a convenience sample of shifts by volunteering emergency physicians (EP) at two urban tertiary care Canadian EDs. EPs completed standardised forms on all patients for whom a consultation was requested. Medical chart reviews and secondary analyses of administrative databases were also performed. Factors associated with longer LOS were determined through linear regression modelling.Results1180 patients received at least one consultation during study shifts and EPs completed data collection on 841 (71%) of these. Median patient age was 54 years, 53.3% were male, and 2.9% had documented dementia. Admitted patients receiving consultations had a longer overall LOS compared to discharged patients. Median time from triage to consultation request accounted for approximately 28% of the total median LOS in admitted patients compared to 46% for discharged patients. Consultation decision time accounted for 33% and 54% of the LOS for admitted and discharged patients, respectively. Linear regression modelling revealed that advanced age, longer latency between arrival and first consultation request, history of dementia and multiple consultations were significantly associated with longer LOS. Conversely, undergoing procedures while in the ED was associated with a shorter LOS.ConclusionsConsultation decision time contributes significantly to ED LOS. Further efforts are needed to validate these results in other ED settings and improve this aspect of ED throughput.