Inpatient disposition classification for the creation of hospital surge capacity: a multiphase study.
Inpatient disposition classification for the creation of hospital surge capacity: a multiphase study.
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DOI：
10.1016/s0140-6736(06)69808-5
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发表时间：
2006-12-02
期刊：
影响因子：
--
通讯作者：
Green GB
中科院分区：
文献类型：
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作者：
Kelen GD;Kraus CK;McCarthy ML;Bass E;Hsu EB;Li G;Scheulen JJ;Shahan JB;Brill JD;Green GB
在灾难或其他高后果事件期间患者数量突然增加时提供医疗服务的能力是卫生保健系统的一个严重问题。确定住院病人的安全早期出院（即反向分诊）可以增加医院的应急处置能力。我们试图开发一种处置分类系统，根据对后续后续医疗事件的风险承受能力，根据立即出院的适宜性对住院患者进行分类。我们利用基于证据的技术，结合39位专家小组成员的共识过程，进行了一场战争分析实验室演习。这些小组成员被要求定义处置分类系统的类别，将后果性医疗事件的风险容忍度分配给每个类别，确定关键干预措施，并根据由于出院而撤回或保留关键干预措施而产生的后果性医疗事件的可能性对每个（使用1-10级）进行排名。小组成员一致同意采用五类处置分类系统。如果提早出院，最低风险组对后续医疗事件的风险承受上限小于4%。接下来的类别的风险承受上限分别为12% （IQR 8-15%）、33%（25-50%）、60%（45-80%）和100%（95-100%）。专家小组成员确定了28项关键干预措施，如果撤销，可能与后果性医疗事件相关，在10分制中从3到10不等。处置分类系统允许对患者进行适当处置的概念分类，包括那些在需求激增期间被认为可以安全提前出院回家的患者。允许患者实时分类的临床标准正在等待中。
The ability to provide medical care during sudden increases in patient volume during a disaster or other high-consequence event is a serious concern for health-care systems. Identification of inpatients for safe early discharge (ie, reverse triage) could create additional hospital surge capacity. We sought to develop a disposition classification system that categorises inpatients according to suitability for immediate discharge on the basis of risk tolerance for a subsequent consequential medical event. We did a warfare analysis laboratory exercise using evidence-based techniques, combined with a consensus process of 39 expert panellists. These panellists were asked to define the categories of a disposition classification system, assign risk tolerance of a consequential medical event to each category, identify critical interventions, and rank each (using a scale of 1–10) according to the likelihood of a resultant consequential medical event if a critical intervention is withdrawn or withheld because of discharge. The panellists unanimously agreed on a five-category disposition classification system. The upper limit of risk tolerance for a consequential medical event in the lowest risk group if discharged early was less than 4%. The next categories had upper limits of risk tolerance of about 12% (IQR 8–15%), 33% (25–50%), 60% (45–80%) and 100% (95–100%), respectively. The expert panellists identified 28 critical interventions with a likelihood of association with a consequential medical event if withdrawn, ranging from 3 to 10 on the 10-point scale. The disposition classification system allows conceptual classification of patients for suitable disposition, including those deemed safe for early discharge home during surges in demand. Clinical criteria allowing real-time categorisation of patients are awaited.