Emergency Department Crowding: Community Determinants and Patient Outcomes

描述（由申请人提供）：急诊科（ED）拥挤已使急症护理系统紧张到其崩溃点。急诊科拥挤的两个最明显的症状是救护车转移和“未被看到就离开”的就诊率，随着时间的推移，这两个症状急剧增加，现在在许多城市中心已经司空见惯。急诊科拥挤导致评估和治疗的延误，这反过来可能导致不良后果。因此，美国急诊医师学会（American College of Emergency Physicians）认定急诊科拥挤是威胁急诊护理安全和质量的首要问题之一。然而，政策制定者和卫生系统领导人未能将急诊科拥挤作为公共卫生的首要任务来解决。不采取行动的主要原因是缺乏关于急诊科拥挤的社区差异和急诊科拥挤对患者预后影响的数据。没有这样的证据，决策者不太可能投入大量资源来解决急诊科拥挤的根本原因。为了评估急诊科拥挤的模式和结果，我们提出了一项回顾性队列研究，对2007年加州非联邦医院急诊科的所有就诊进行研究。该分析将包括来自342名加州急诊室的880万出院病例和150万住院病例。我们将以每日救护车分流时数和“未被诊前离开”的访视率作为衡量急诊科拥挤程度的指标。本研究的具体目的如下：

DESCRIPTION (provided by the applicant): Emergency department (ED) crowding has strained the acute care system to its breaking point. Two of the most visible symptoms of ED crowding, ambulance diversion and 'left before being seen' visit rates, have dramatically increased over time and are now routine in many urban centers. ED crowding causes delays in evaluation and treatment, which in turn may contribute to adverse outcomes. Consequently, the American College of Emergency Physicians has identified ED crowding as one of the top problems threatening the safety and quality of emergency care. However, policymakers and health system leaders have failed to address emergency department crowding as a top public health priority. The primary reason for inaction is the paucity of data on community disparities in ED crowding and the impact of ED crowding on patient outcomes. Without such evidence, policymakers are unlikely to commit substantial resources to address root causes of ED crowding. In order to assess patterns and outcomes of ED crowding, we propose a retrospective cohort study of all 2007 ED visits to non-federal, California hospitals. This analysis will include 8.8 million discharges and 1.5 million hospitalizations from 342 California EDs. We will use daily ambulance diversion hours and 'left before being seen' (LBBS) visit rates as measures of ED crowding. This study has the following Specific Aims: 1. Identify community level predictors of emergency department crowding. 2. Assess the relationship between emergency department crowding and 7-day bounce-back hospitalizations after emergency department discharge. 3. Assess the relationship between emergency department crowding and inpatient outcomes, including death, length-of-stay, and costs. California accounts for nearly 10% of all ED visits in the United States and represents a diversity of patient populations and hospital systems. Therefore, the proposed study will provide generalizable insights into this health policy crisis.