The effects of emergency department crowding on triage and hospital admission decisions
The effects of emergency department crowding on triage and hospital admission decisions
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DOI：
10.1016/j.ajem.2019.06.039
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发表时间：
2020-04-01
影响因子：
3.6
通讯作者：
Ziya, Serhan
中科院分区：
文献类型：
--
作者：
Chen, Wanyi;Linthicum, Benjamin;Ziya, Serhan
背景资料：急诊科（艾德）拥挤是一个公认的问题，它已被建议，它可以影响临床医生decision-making.Objectives：我们的目的是确定是否艾德人口普查与分流或处置决策的变化由艾德nurses and physics.Methods：我们进行了一项回顾性研究，使用一年的数据从美国学术中心艾德（65,065例患者接触后清洗）。使用累积logit模型，我们调查了患者的急性组（低，中，高）和分诊时的艾德普查之间的关联。我们还使用多变量逻辑回归来研究患者的处置决定（入院或出院）与处置决定时的艾德普查之间的关联。在这两项研究中，控制变量包括人口普查，年龄，性别，种族，治疗地点，主诉，和某些相互作用terms.Results：我们发现统计学显着相关性之间的艾德人口普查和分流/处置决定。对于艾德中的每一个额外的患者，在分诊时被分配为高敏度的几率比中敏度或低敏度高1.011倍（比值比[OR]的95%置信区间[CI]= [1.009，1.012]），在分诊时被分配为中等或高敏度的比值比低敏度高1.009倍（OR的95%CI = [1.008，1.010]）。同样，被承认与出院的几率增加了1.007倍（95%CI OR = [1.006，1.008]），每增加一个病人在艾德在处置decision.Conclusion：增加艾德占用率被发现与更多的患者被归类为更高的敏锐度以及更高的住院率。例如，对于通常观察到的患者类别，我们的模型预测，随着艾德占用率从25名患者增加到75名患者，患者被分诊为高急性的概率增加约50%，并且患者被分类为入院的概率增加约25%。(c)2019由Elsevier Inc.出版
Background: Emergency department (ED) crowding is a recognized issue and it has been suggested that it can affect clinician decision-making.Objectives: Our objective was to determine whether ED census was associated with changes in triage or disposition decisions made by ED nurses and physicians.Methods: We performed a retrospective study using one year of data obtained from a US academic center ED (65,065 patient encounters after cleaning). Using a cumulative logit model, we investigated the association between a patient's acuity group (low, medium, and high) and ED census at triage time. We also used multivariate logistic regression to investigate the association between the disposition decision for a patient (admit or discharge) and the ED census at the disposition decision time. In both studies, control variables included census, age, gender, race, place of treatment, chief complaint, and certain interaction terms.Results: We found statistically significant correlation between ED census and triage/disposition decisions. For each additional patient in the ED, the odds of being assigned a high acuity versus medium or low acuity at triage is 1.011 times higher (95% confidence interval [CI] for Odds Ratio [OR]= [1.009,1.012]), and the odds of being assigned medium or high acuity versus low acuity at triage is 1.009 times higher (95% CI for OR = [1.008,1.010]). Similarly, the odds of being admitted versus discharged increases by 1.007 times (95% CI for OR = [1.006,1.008]) per additional patient in the ED at the time of disposition decision.Conclusion: Increased ED occupancy was found to be associated with more patients being classified as higher acuity as well as higher hospital admission rates. As an example, for a commonly observed patient category, our model predicts that as the ED occupancy increases from 25 to 75 patients, the probability of a patient being triaged as high acuity increases by about 50% and the probability of a patient being categorized as admit increases by around 25%. (c) 2019 Published by Elsevier Inc.