Impact of rapid entry and accelerated care at triage on reducing emergency department patient wait times, lengths of stay, and rate of left without being seen
Impact of rapid entry and accelerated care at triage on reducing emergency department patient wait times, lengths of stay, and rate of left without being seen
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DOI：
10.1016/j.annemergmed.2005.06.013
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发表时间：
2005-12-01
影响因子：
6.2
通讯作者：
Guss, DA
中科院分区：
文献类型：
--
作者：
Chan, TC;Killeen, JP;Guss, DA
研究目标：对于许多急诊科 (ED) 来说，在就医之前离开的患者是一个重大问题。我们试图确定新的急诊快速入院和加速分诊护理 (REACT) 流程对就诊前离开的患者频率的影响。方法：我们进行了前后干预设计，以研究 REACT 对到我们城市学术中心急诊科就诊的门诊患者的影响，人口普查了大约 37,000 名患者。该流程重新设计包括患者识别跟踪、集成计算机界面以消除预先登记任务、立即将患者安置在开放式急诊床位以及在没有可用急诊室床位时进行医生指导的辅助测试和分诊护理。结果指标包括在开始前 6 个月（REACT 前）和开始后 6 至 12 个月（REACT 后）期间离开就诊的患者的平均每月比率。其他衡量标准包括平均每月等待时间率、急诊科住院时间、急诊科普查和入院人数。结果：尽管急诊科普查总体有所增加，但从 REACT 前到 REACT 后期间，就诊前请假的频率显着下降（绝对下降 3.2% [95% 置信区间 (CI) 1.9% 至 4.6%]）。启动 REACT 后，患者每月平均等待时间减少了 24 分钟 [95% Cl 10 至 38 分钟]，急诊总住院时间减少了 31 分钟 [95% Cl 6 至 57 分钟]。结论：尽管患者普查总体有所增加，但快速进入和加速护理流程的启动显着降低了患者就诊前离开率、平均等待时间和住院时间。
Study objective: Patients who leave before being seen by a physician represent a significant problem for many emergency departments (EDs). We sought to determine the effect of a new ED rapid entry and accelerated care at triage (REACT) process on the frequency of patients who leave before being seen.Methods: We conducted a before-after intervention design to study the effect of REACT for ambulatory patients presenting to our urban academic center ED with a census of approximately 37,000. This process redesign included patient identification tracking, integrated computer interfaces to eliminate up-front registration tasks, immediate placement of patients in open ED beds, and physician-directed ancillary testing and care at triage when no ED beds were available. Outcome measures included the average monthly rate of patients who left before being seen during the 6 months before (pre-REACT) and 6 to 12 months after (post-REACT) its initiation. Other measures included average of mean monthly rates of wait times, ED length of stay, ED census, and admissions.Results: There was a significant decrease in leave before being seen frequency from the pre-REACT to post-REACT periods (3.2% absolute decrease [95% confidence interval (CI) 1.9% to 4.6%]), despite an overall increase in ED census. Average mean monthly patient wait times decreased by 24 minutes [95% Cl 10 to 38 minutes] after the initiation of REACT, as did overall ED length of stay by 31 minutes [95% Cl 6 to 57 minutes].Conclusion: The initiation of a rapid entry and accelerated care process significantly decreased patient leave before being seen rates, average wait times and length of stay, despite an overall increase in patient census.