Intervention to decrease emergency department crowding: Does it have an effect on return visits and hospital readmissions?
Intervention to decrease emergency department crowding: Does it have an effect on return visits and hospital readmissions?
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DOI：
10.1067/mem.2003.50
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发表时间：
2003-02-01
影响因子：
6.2
通讯作者：
Guttman, A
中科院分区：
文献类型：
--
作者：
Cardin, S;Afilalo, M;Guttman, A
研究目的：我们评估了多方面干预对减少急诊室拥挤对艾德或医院病房复诊率的影响。干预措施包括增加急诊医生的覆盖面，指定医生协调员，以及关于实验室，咨询和入院程序的新医院政策。方法：在2个人群的样本中估计了出院后7天内回访的发生率（即，从艾德出院的患者和从医院出院的患者）以及之前12个月期间和12个月期间，干预实施后一个月内。回访分为以下几组：（1）计划访视或非计划访视，（2）与初始访视相关或无关。在控制潜在混杂因素的同时，在子样本中使用逻辑回归来评估干预的效果。通过使用省级医疗服务数据库中的信息，比较研究医院和2家外部对照医院之间实施干预前后任何艾德回访发生率的变化。干预前后回访率无差异，对于从艾德出院的患者（所有退货：11.0% vs 12.4%，差异的95%置信区间[CID] -1.5%至4.3%;非计划相关退货：6.5% vs 5.8%，95% CID -2.8%至1.6%）或医院（所有回报率：6.8%对6.6%，95% CID -2.5%至2.1%;非计划相关回报率：4.2%对4.0%，95% CID -2.0%至1.7%）。即使在控制了潜在混杂因素后，这种缺乏效应的情况仍然存在。之间的变化期间之前和之后实施的干预措施的发生率返回任何艾德是类似的3 hospitals examined.Conclusion：我们成功的医院干预措施，以减少拥挤的平均住院时间从艾德从13.8小时至5.9小时出院的患者，而不会导致增加回访的艾德或再次入院。
Study objectives: We evaluate the effect of a multifaceted intervention to decrease emergency department crowding on the incidence of return visits to the ED or a hospital ward. The intervention included increased emergency physician coverage, the designation of physician coordinators, and new hospital policies regarding laboratory, consultation, and admission procedures.Methods: The incidence of return visits within 7 days of discharge was estimated in samples from 2 populations (ie, patients discharged from the ED and patients discharged from the hospital) and during a 12-month period before and a 12-month period after the implementation of the intervention. Return visits were categorized into the following groups: (1) scheduled or not and (2) related or not to initial visit. Logistic regression was used in subsamples to assess the effect of the intervention while controlling for potential confounders. By using information from the provincial medical services database, variation between the periods before and after implementation of the intervention in the incidence of return visits to any ED was compared between the study hospital and 2 external control hospitals.Results: No difference was found in the incidence of return visits between the periods before and after implementation of the intervention, either for patients discharged from the ED (all returns: 11.0% versus 12.4%, 95% confidence interval on difference [CID] -1.5% to 4.3%; unscheduled-related returns: 6.5% versus 5.8%, 95% CID -2.8% to 1.6%) or the hospital (all returns: 6.8% versus 6.6%, 95% CID -2.5% to 2.1%; unscheduled-related returns: 4.2% versus 4.0%, 95% CID -2.0% to 1.7%). This lack of effect remained even after controlling for potential confounders. Variation between the periods before and after implementation of the intervention in the incidence of return to any ED was similar in the 3 hospitals examined.Conclusion: Our successful hospital intervention to decrease crowding reduced the mean length of stay for patients discharged from the ED from 13.8 to 5.9 hours, without resulting in increased return visits to the ED or hospital readmission.