National Trends in Emergency Department Occupancy, 2001 to 2008: Effect of Inpatient Admissions Versus Emergency Department Practice Intensity
National Trends in Emergency Department Occupancy, 2001 to 2008: Effect of Inpatient Admissions Versus Emergency Department Practice Intensity
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DOI：
10.1016/j.annemergmed.2012.05.014
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发表时间：
2012-12-01
影响因子：
6.2
通讯作者：
Kellermann, Arthur L.
中科院分区：
文献类型：
--
作者：
Pitts, Stephen R.;Pines, Jesse M.;Kellermann, Arthur L.
研究目的：通过对急诊科占用率的分析，评估急诊科拥挤的近期趋势及其潜在原因。方法：我们分析了2001-2008年间全国医院门诊医疗服务年度调查的数据。这些调查从全国医院急救人员的样本中提取患者记录，以生成具有全国代表性的就诊估计。结果：在8年的研究期间，急诊室就诊次数每年增长1.9%(95%可信区间为1.2%~2.5%)，比人口增长快60%。平均入住率的增长甚至更快，在8个研究年度中，平均入住率为3.1%(95%可信区间为2.3%至3.8%)，或27%。在与拥挤相关的潜在因素中，先进成像技术的使用增加最多，增加了140%。但与其他更常见的吞吐量因素相比，先进的成像技术对入住率趋势的影响较小，例如使用静脉输液和血液测试，任何临床操作的性能，以及提到两种或更多药物。在患者特征中，医保缴费者身份和45岁至年龄组的占有率略有不成比例的增加。结论：尽管一再呼吁采取行动，但急诊室拥挤状况正在恶化。社会人口结构的变化在一定程度上解释了入住率的增加，但练习强度是推动入住率上升的主要因素。尽管入院导致急诊室的住院时间比其他任何因素都长，但这并没有影响入住率的急剧上升。访问数/每百万人：Reach for[Ann Emerg2012；60：679-686。]
Study objective: We evaluate recent trends in emergency department (ED) crowding and its potential causes by analyzing ED occupancy, a proxy measure for ED crowding.Methods: We analyzed data from the annual National Hospital Ambulatory Medical Care Surveys from 2001 to 2008. The surveys abstract patient records from a national sample of hospital EDs to generate nationally representative estimates of visits. We used time of ED arrival and length of ED visit to calculate mean and hourly ED occupancy.Results: During the 8-year study period, the number of ED visits increased by 1.9% per year (95% confidence interval 1.2% to 2.5%), a rate 60% faster than population growth. Mean occupancy increased even more rapidly, at 3.1.% per year (95% confidence interval 2.3% to 3.8%), or 27% during the 8 study years. Among potential factors associated with crowding, the use of advanced imaging increased most, by 140%. But advanced imaging had a smaller effect on the occupancy trend than other more common throughput factors, such as the use of intravenous fluids and blood tests, the performance of any clinical procedure, and the mention of 2 or more medications. Of patient characteristics, Medicare payer status and the age group 45 to 64 years accounted for small disproportionate increases in occupancy.Conclusion: Despite repeated calls for action, ED crowding is getting worse. Sociodemographic changes account for some of the increase, but practice intensity is the principal factor driving increasing occupancy levels. Although hospital admission generated longer ED stays than any other factor, it did not influence the steep trend in occupancy. [Ann Emerg Med. 2012;60:679-686.]