National Study of Non-urgent Emergency Department Visits and Associated Resource Utilization
National Study of Non-urgent Emergency Department Visits and Associated Resource Utilization
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DOI：
10.5811/westjem.2013.5.16112
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发表时间：
2013-11-01
影响因子：
3.1
通讯作者：
Ginde, Adit A.
中科院分区：
文献类型：
--
作者：
Honigman, Leah S.;Wiler, Jennifer L.;Ginde, Adit A.
引言：减少非紧急急诊科（艾德）的访问一直是一种节省成本的方法。为了更好地描述这些访问，我们试图比较资源利用的艾德访问的特点是非紧急分诊立即，紧急，或紧急（IEU）visits.Methods：我们进行了回顾性，横断面分析2006-2009年全国医院门诊医疗服务调查。使用指定的5级分诊视力评分对访视的紧急程度进行分类。我们分析了资源利用，包括诊断测试，治疗和住院治疗中的每一个急性category.Results：从2006年至2009年，10.1%（95%置信区间[CI]，9.2-11.2）的美国艾德访问被归类为非紧急。大多数（87.8% [95% CI，86.3-89.2]）非紧急访视在ED中进行了一些诊断检查或治疗。成像在非紧急访视中很常见（29.8% [95% CI，27.8-31.8]），但不像IEU访视那样频繁（52.9% [95% CI，51.6-54.2]）。同样，与IEU访视（56.3% [95% CI，53.5-59.0]）相比，非紧急（34.1% [95% CI，31.8-36.4]）的手术频率较低。两组之间的药物给药相似（分别为80.6% [95% CI，79.5-81.7] vs. 76.3% [95% CI，74.7-77.8]）。住院率为4.0%（95% CI，3.3-4.8）vs. 19.8% IEU访视（95% CI，18.4-21.3），0.5%的非紧急访视进入重症监护室（95%CI，0.3-0.6）vs. 3.4%（95%CI，3.1-3.8）的IEU visits.Conclusions：对于大多数非紧急艾德访问，进行了一些诊断或治疗干预。非紧急艾德就诊的比例相对较低，但值得注意的是，有时是重症监护。这些数据对被归类为“不必要”的非紧急艾德就诊提出了质疑，特别是在对急性疾病或损伤及时获得初级保健的机会有限的情况下。
Introduction: Reducing non-urgent emergency department (ED) visits has been targeted as a method to produce cost savings. To better describe these visits, we sought to compare resource utilization of ED visits characterized as non-urgent at triage to immediate, emergent, or urgent (IEU) visits.Methods: We performed a retrospective, cross-sectional analysis of the 2006-2009 National Hospital Ambulatory Medical Care Survey. Urgency of visits was categorized using the assigned 5-level triage acuity score. We analyzed resource utilization, including diagnostic testing, treatment, and hospitalization within each acuity categorization.Results: From 2006-2009, 10.1% (95% confidence interval [CI], 9.2-11.2) of United States ED visits were categorized as non-urgent. Most (87.8% [95% CI, 86.3-89.2]) non-urgent visits had some diagnostic testing or treatment in the ED. Imaging was common in non-urgent visits (29.8% [95% CI, 27.8-31.8]), although not as frequent as for IEU visits (52.9% [95% CI, 51.6-54.2]). Similarly, procedures were performed less frequently for non-urgent (34.1% [95% CI, 31.8-36.4]) compared to IEU visits (56.3% [95% CI, 53.5-59.0]). Medication administration was similar between the 2 groups (80.6% [95% CI, 79.5-81.7] vs. 76.3% [95% CI, 74.7-77.8], respectively). The rate of hospital admission was 4.0% (95% CI, 3.3-4.8) vs. 19.8% (95% CI, 18.4-21.3) for IEU visits, with admission to a critical care setting for 0.5% of non-urgent visits (95% CI, 0.3-0.6) vs. 3.4% (95% CI, 3.1-3.8) of IEU visits.Conclusions: For most non-urgent ED visits, some diagnostic or therapeutic intervention was performed. Relatively low, but notable proportions of non-urgent ED visits were admitted to the hospital, sometimes to a critical care setting. These data call into question non-urgent ED visits being categorized as "unnecessary," particularly in the setting of limited access to timely primary care for acute illness or injury.