US emergency department performance on wait time and length of visit.
US emergency department performance on wait time and length of visit.
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DOI：
10.1016/j.annemergmed.2009.07.023
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发表时间：
2010-02
影响因子：
6.2
通讯作者：
Bradley, Elizabeth H.
中科院分区：
文献类型：
--
作者：
Horwitz, Leora I.;Green, Jeremy;Bradley, Elizabeth H.
延长急诊科(ED)的等待时间和就诊时间会降低护理质量并增加不良事件。以前的研究没有检查美国医院层面对急诊室等待时间和就诊时间的表现。这项研究的目的是描述医院层面在急诊室等待时间和就诊时间方面的表现。2006年，我们对364家非联邦医院急诊室的35,849名患者进行了分层随机抽样的回顾性横断面研究，加权后为4,654家急诊室的119,191,528次就诊。衡量标准包括急诊室的中位等待时间和就诊时间，急诊室在分诊时医生推荐的时间内看过的患者的中位数比例，以及急诊室在4或6小时内处理的患者的中位数比例。在中位数ED中，78.3%(四分位数范围[IQR]，63.2%，89.5%)的患者和66.9%(IQR，52.0%，81.9%)的患者在目标分流时间内被医生看到。共有30.5%的急症室达到了90%以上患者的分流目标；13.8%的急诊室达到了90%或更多患者分流到一小时内就诊的目标。在中位数ED中，76.3%(IQR 54.4%，93.9%)的患者在6小时内入院。共有47.7%的急诊室在6小时内接纳90%以上的病人，但只有24.5%的急症室在4小时内接纳90%以上的病人。少数医院始终达到所有ED患者的推荐等待时间，只有不到一半的医院始终在6小时内接纳其ED患者。
Prolonged emergency department (ED) wait time and length of visit reduce quality of care and increase adverse events. Previous studies have not examined hospital-level performance on ED wait time and visit length in the United States. The purpose of this study is to describe hospital-level performance on ED wait time and visit length. We conducted a retrospective cross-sectional study of a stratified random sampling of 35,849 patient visits to 364 non-Federal U.S. hospital EDs in 2006, weighted to represent 119,191,528 visits to 4,654 EDs. Measures included EDs' median wait times and visit lengths, EDs' median proportion of patients seen by a physician within the time recommended at triage, and EDs' median proportion of patients dispositioned within 4 or 6 hours. In the median ED, 78.3% (interquartile range [IQR], 63.2%, 89.5%) of all patients, and 66.9% (IQR, 52.0%, 81.9%) of patients who were triaged to be seen within one hour were seen by a physician within the target triage time. A total of 30.5% of EDs achieved the triage target for more than 90% of their patients; 13.8% of EDs achieved the triage target for 90% or more of patients triaged to be seen within an hour. In the median ED, 76.3% (IQR 54.4%, 93.9%) of patients were admitted within 6 hours. A total of 47.7% of EDs admitted more than 90% of their patients within 6 hours, but only 24.5% of EDs admitted more than 90% of their patients within 4 hours. A minority of hospitals consistently achieved recommended wait times for all ED patients, and fewer than half of hospitals consistently admitted their ED patients within 6 hours.
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