The association between hospital overcrowding and mortality among patients admitted via Western Australian emergency departments
The association between hospital overcrowding and mortality among patients admitted via Western Australian emergency departments
复制标题
DOI：
10.5694/j.1326-5377.2006.tb00203.x
复制
发表时间：
2006-03-06
影响因子：
11.4
通讯作者：
Jelinek, GA
中科院分区：
文献类型：
--
作者：
Sprivulis, PC;Da Silva, JA;Jelinek, GA
目的：检查医院和急诊科 (ED) 占用率之间的关系，作为医院过度拥挤和急诊入院后死亡率的指标。设计：对 62495 例概率相关的急诊入院和死亡记录进行回顾性分析。背景：2000 年 7 月至 2003 年 6 月期间的三所三级大都市医院。参与者：所有在研究期间首次 ED 就诊并导致入院的 18 岁或以上患者。结果测量：在调整年龄、诊断、转诊来源、紧急程度和前往医院的交通方式后，根据医院和急诊室占用情况，根据过度拥挤危险量表评估第 2、7 和 30 天的死亡人数。结果：过度拥挤危险量表与第 7 天的死亡人数之间存在线性关系（r = 0.98；95% Cl，0.79-1.00）。过度拥挤危险等级 > 2 与第 2 天、第 7 天和第 30 天的死亡风险比增加相关，分别为 1.3 (95% Cl, 1.1-1.6)、1.3 (95% Cl, 1.2-1.5) 和 1.2 (95% Cl, 1.1-1.3)。与过度拥挤危险等级 > 2 和 < 3 之一相关的 30 天死亡在年龄、诊断、紧急程度、交通方式、转诊来源或住院时间方面没有差异，但急诊室住院时间较长（急诊室住院每小时的风险比，1.1；95% Cl，1.1-1.1；P < 0.001）和医生等待时间较长（急诊室等待的每小时风险比， 1.2；95% Cl，1.1-1.3；P = 0.01）。结论：医院和急诊室过度拥挤与死亡率增加有关。过度拥挤危险量表可用于评估与医院和急诊室过度拥挤相关的危险。减少过度拥挤可能会改善需要紧急入院的患者的预后。
Objective: To examine the relationship between hospital and emergency department (ED) occupancy, as indicators of hospital overcrowding, and mortality after emergency admission.Design: Retrospective analysis of 62495 probabilistically linked emergency hospital admissions and death records.Setting: Three tertiary metropolitan hospitals between July 2000 and June 2003.Participants: All patients 18 years or older whose first ED attendance resulted in hospital admission during the study period.Main outcome measures: Deaths on days 2, 7 and 30 were evaluated against an Overcrowding Hazard Scale based on hospital and ED occupancy, after adjusting for age, diagnosis, referral source, urgency and mode of transport to hospital.Results: There was a linear relationship between the Overcrowding Hazard Scale and deaths on Day 7 (r = 0.98; 95% Cl, 0.79-1.00). An Overcrowding Hazard Scale > 2 was associated with an increased Day 2, Day 7 and Day 30 hazard ratio for death of 1.3 (95% Cl, 1.1-1.6),1.3 (95% Cl, 1.2-1.5) and 1.2 (95% Cl, 1.1-1.3), respectively. Deaths at 30 days associated with an Overcrowding Hazard Scale > 2 compared with one of < 3 were undifferentiated with respect to age, diagnosis, urgency, transport mode, referral source or hospital length of stay, but had longer ED durations of stay (risk ratio per hour of ED stay, 1.1; 95% Cl, 1.1-1.1; P < 0.001) and longer physician waiting times (risk ratio per hour of ED wait, 1.2; 95% Cl, 1.1-1.3; P = 0.01).Conclusions: Hospital and ED overcrowding is associated with increased mortality. The Overcrowding Hazard Scale may be used to assess the hazard associated with hospital and ED overcrowding. Reducing overcrowding may improve outcomes for patients requiring emergency hospital admission.