Emergency department crowding and decreased quality of pain care.
Emergency department crowding and decreased quality of pain care.
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DOI：
10.1111/j.1553-2712.2008.00267.x
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发表时间：
2008-12
期刊：
影响因子：
--
通讯作者：
Sean Morrison R
中科院分区：
文献类型：
--
作者：
Hwang U;Richardson L;Livote E;Harris B;Spencer N;Sean Morrison R
本研究的目的是评估急诊科（艾德）拥挤因素与疼痛护理质量的关系。这是一项回顾性观察性研究，研究对象为2005年7月1日至7月31日和2005年12月1日至12月31日在学术性城市三级护理艾德就诊的所有患有疼痛护理障碍的成人患者（≥18岁）。如果患者主诉为疼痛，并且最终艾德诊断为疼痛，则将其纳入。研究的预测艾德拥挤变量为：1）人口普查，2）等待住院床位的住院患者数量（寄宿生），3）寄宿生数量除以艾德人口普查（寄宿负担）。感兴趣的结果是疼痛护理措施的过程：临床医生疼痛评估的记录、订购的药物和活动时间（例如，到达、评估、订购药物）。共审查了1，068例患者访视。在高人口普查期间（>第50百分位数），接受镇痛药物治疗的患者较少（参数估计值=-0.47 [95% CI =-0.80 to-0.07]）。与总的艾德普查直接相关，增加了：疼痛评估时间（斯皮尔曼r = 0.33，p < 0.0001），止痛药物订购时间（r = 0.22，p < 0.0001）和止痛药物给药时间（r = 0.25，p < 0.0001）。在高艾德人口普查和寄宿人数期间，疼痛评估和止痛药物的订购和管理存在显著延迟（>1小时），但不存在寄宿负担。艾德拥挤如通过患者体积测量的对患者护理产生负面影响。在艾德，无论是作为总人口普查或寄宿生的数量，更大的病人数量与更差的疼痛护理。
The objective of this study was to evaluate the association of emergency department (ED) crowding factors with the quality of pain care. This was a retrospective observational study of all adult patients (≥18 years) with conditions warranting pain care seen at an academic, urban tertiary care ED from July 1 to July 31, 2005, and December 1 to December 31, 2005. Patients were included if they presented with a chief complaint of pain and a final ED diagnosis of a painful condition. Predictor ED crowding variables studied were: 1) census, 2) number of admitted patients waiting for inpatient beds (boarders), and 3) number of boarders divided by ED census (boarding burden). The outcomes of interest were process of pain care measures: documentation of clinician pain assessment, medications ordered, and times of activities (e.g., arrival, assessment, ordering of medications). A total of 1,068 patient visits were reviewed. Fewer patients received analgesic medication during periods of high census (>50th percentile) (Parameter estimate = −0.47 [95% CI = −0.80 to −0.07]). There was a direct correlation with total ED census and increased: time to pain assessment (Spearman r = 0.33, p < 0.0001), time to analgesic medication ordering (r = 0.22, p < 0.0001), and time to analgesic medication administration (r = 0.25, p < 0.0001). There were significant delays (>1-hour) for pain assessment and the ordering and administration of analgesic medication during periods of high ED census and number of boarders, but not with boarding burden. ED crowding as measured by patient volume negatively impacts patient care. Greater numbers of patients in the ED, whether as total census or number of boarders, were associated with worse pain care.
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影响因子：
6.2
作者：
Gilbert, EH;Lowenstein, SR;Steiner, J
通讯作者：
Steiner, J
影响因子：
4.4
作者：
Hwang, U;Concato, J
通讯作者：
Concato, J
影响因子：
5.9
作者：
Luck, J;Peabody, JW;Glassman, P
通讯作者：
Glassman, P
影响因子：
3.6
作者：
Fosnocht, DE;Heaps, ND;Swanson, ER
通讯作者：
Swanson, ER
DOI：
10.1111/j.1532-5415.2005.00587.x
发表时间：
2006-02-01
影响因子：
6.3
作者：
Hwang, U;Richardson, LD;Morrison, RS
通讯作者：
Morrison, RS