A 5-year time study analysis of emergency department patient care efficiency
A 5-year time study analysis of emergency department patient care efficiency
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DOI：
10.1016/s0196-0644(99)70126-5
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发表时间：
1999-09-01
影响因子：
6.2
通讯作者：
Talan, DA
中科院分区：
文献类型：
--
作者：
Kyriacou, DN;Ricketts, V;Talan, DA
研究目的：我们对急诊科患者护理效率进行了为期5年的研究分析。我们的具体目标是(1)计算急诊科患者的主要护理时间间隔，以确定效率低下的领域；(2)衡量急诊科和住院床位可用性对患者流量的影响；(3)定量评估旨在提高效率的行政干预措施的效果；(4)评估等待看医生的时间与未被医生看到的患者数量之间的关系。方法：从1993年9月至1998年7月，采用相同的研究设计和方法对7例1周ED患者进行血流时间研究。以胸痛、腹痛、阴道出血和四肢损伤为主诉的患者被纳入我们洛杉矶县医院急诊科，以代表患者病情的严重程度。计算的时间间隔代表了评估和治疗的主要阶段：(1)分诊到完成登记，(2)完成登记到进入急诊科治疗区，(3)进入急诊科治疗区进行初步医疗评估，(4)分诊介绍到初始医疗评估，(5)初始医疗评估到处置令，(6)处置令到患者从急诊科出院。急诊科总住院时间（LOS）也被计算为效率的总体衡量标准。时间间隔根据急诊科和医院住院床位的可用性进行比较。评估了行政干预对特定时间间隔的影响。评估了中位等待就诊时间与LWBS患者数量之间的关系。行政干预由一个专门的跨部门持续质量改进委员会实施。干预措施的目的是针对时间研究确定的造成延误和效率低下的具体原因。结果：7项时间研究共纳入826例患者。急诊科和住院床位的缺乏与严重的延误有关。在前5个时期，ED总LOS的中位数从6.8小时显著减少到4.6小时，这可能是行政干预的结果。然而，在过去的两个时间段内，急诊总时间的中位数从4.6小时增加到6.0小时，这可能是由于最近洛杉矶县财政危机导致急诊患者人口普查的增加和护理人员和医生人员的减少。LWBS患者数量与就诊等待时间密切相关（r=0.79, beta=5.20， P= 0.033）。结论：时间研究是确定患者护理延误区域的有效方法。在我们的ED中，有针对性的行政干预明显降低了ED的总LOS并提高了整体效率。尽管急诊科的LOS最初有所下降，但由于护理和医生人员的减少以及患者普查的增加，效率似乎受到了不利影响。等待就诊时间与LWBS患者数量之间的关系表明，减少等待时间可能会减少LWBS患者的数量。
Study objectives: We conducted a 5-year time study analysis of emergency department patient care efficiency. Our specific aims were (1) to calculate the main ED patient care time intervals to identify areas of inefficiency, (2) to measure the effect of ED and inpatient bed availability on patient flow, (3) to quantitatively assess the effects of administrative interventions aimed at improving efficiency, and (4) to evaluate the relationship between waiting times to see a physician and the number of patients who leave without being seen (LWBS) by a physician.Methods: Seven 1-week ED patient flow time studies were conducted from September 1993 to July 1998 using identical study design and methodology. Patients presenting with complaints of chest pain, abdominal pain, vaginal bleeding, and extremity injury were included to represent the level of severity of patient conditions seen in our los Angeles County hospital ED. The calculated time intervals representing the main phases of evaluation and treatment were (1)triage presentation to completion of registration, (2) completion of registration to ED treatment area entry, (3) ED treatment area entry to initial medical assessment, (4) triage presentation to initial medical assessment, (5) initial medical assessment to disposition order, and (6) disposition order to patient discharge from the ED. Total ED lengths of stay (LOS) were also calculated as overall measures of efficiency. Time intervals were compared depending on the availability of ED and hospital inpatient beds. The effects of administrative interventions on the specific time intervals were assessed. The relationship between the median waiting time to see a physician and the number of LWBS patients was evaluated. Administrative interventions were implemented by a special interdepartmental continuous quality improvement committee. Interventions were aimed at specific sources of delay and inefficiency identified by the time studies.Results: Eight hundred twenty-six patients were included in the 7 time studies. The unavailability of ED and inpatient beds was associated with significant delays. There was a significant reduction of the median total ED LOS from 6.8 hours to 4.6 hours over the first 5 periods, presumably resulting from the administrative interventions. Median total ED LOS, however, increased from 4.6 hours to 6.0 hours during the last 2 periods, possibly as a result of an increase in our ED patient census and reductions in both nursing and physician staffing imposed by the recent Los Angeles County fiscal crisis. The number of LWBS patients was closely correlated to waiting time to see a physician (r=0.79, beta=5.20, P=.033).Conclusion: Time studies are an effective method of identifying areas of patient care delay. In our ED, targeted administrative interventions apparently reduced the total ED LOS and improved overall efficiency. Despite initial decreases in ED LOS, efficiency appeared to be adversely affected by reductions in nursing and physician staffing and increases in our patient census. The strength of the relationship between waiting times to see a physician and the number of LWBS patients suggests that decreasing waiting times may reduce the number of LWBS patients.