Identifying Hospital Practices to Reduce Emergency Department Crowding.

确定医院的做法以减少急诊科拥挤。

• 批准号: 8696129
• 负责人: Benjamin C Sun
• 金额: $ 23.1万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-06-15 至 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8696129
• 关键词: Accident and Emergency department; Acute; Address; Ambulances; American; Beds; Benchmarking; Caring; Case Mixes; Cessation of life; Client satisfaction; Crowding; Data; Discipline of Nursing; Emergency Department Physician; Emergency Medicine; Evaluation; Exposure to; Goals; Healthcare; Hospitalists; Hospitals; Inpatients; Institute of Medicine (U.S.); Intensive Care Units; Intervention; Interview; Knowledge; Left; Length of Stay; Literature; Measures; Medical; Medicare; Medicine; Natural experiment; Operations Research; Operative Surgical Procedures; Organizational Change; Outcome; Patients; Performance; Plant Roots; Process; Public Health; Qualitative Research; Relative Risks; Reporting; Research; Research Methodology; Research Personnel; Safety; Sampling; Surveys; Symptoms; Taxonomy; Visit; college; comparative effectiveness; hospital bed; improved; mortality; novel; operation; patient safety; programs; public health relevance; satisfaction; tool

DESCRIPTION (provided by applicant): The Institute of Medicine and the American College of Emergency Physicians have identified emergency department (ED) crowding as a critical threat to public safety. Exposure to dangerously crowded ED conditions is associated with a 30-80% relative risk increase in short-term mortality and results in decreased timeliness of care, lower patient satisfaction, and disparities in healthcare access. However, effective strategies to reduce ED crowding remain ill-defined despite a decade of operations research. The long term-goal of our research program is to eliminate patient harms associated with ED crowding. To address the limitations of the existing literature, we propose a hypothesis-generating study to identify, classify, and measure hospital practices to reduce ED crowding. Our qualitative research plan will study natural experiments at hospitals with varying levels of performance. This project will be performed in partnership with the ED Benchmarking Alliance (EDBA), which is a unique collaborative of over 800 hospitals that collects standardized ED crowding data. This proposal will create the tools to perform a national comparative-effectiveness study of hospital practices to reduce ED crowding. We will achieve the following Specific Aims: Aim 1. Identify hospital practices directed at reducing emergency department crowding. Aim 2. Develop a reliable and valid survey to measure hospital practices directed at reducing emergency department crowding. Subsequent research will combine originally collected survey data from a national random sample of hospitals with public reports of performance on ED crowding measures (released by Medicare in early 2013)~ quantitative analyses will assess the impact of different hospital practices on ED crowding and patient relevant outcomes such as mortality and satisfaction. Our long-term research plan has high potential to change the organizational standard-of-care and to eliminate patient harms caused by ED crowding.

描述（由申请人提供）：医学研究所和美国急诊医师学院已确定急诊科（艾德）拥挤是对公共安全的重大威胁。暴露于危险拥挤的艾德条件下与短期死亡率的30 - 80%相对风险增加相关，并导致护理及时性降低，患者满意度降低以及医疗保健获得的差异。然而，有效的减少战略 艾德拥挤仍然不明确，尽管十年的业务研究。 我们研究项目的长期目标是消除与艾德拥挤相关的患者伤害。为了解决现有文献的局限性，我们提出了一个假设生成的研究，以确定，分类和衡量医院的做法，以减少艾德拥挤。我们的定性研究计划将研究在不同水平的性能医院的自然实验。该项目将与艾德基准联盟（EDBA）合作进行，EDBA是一个由800多家医院组成的独特合作组织，收集标准化的艾德拥挤数据。该提案将创建工具，对医院减少艾德拥挤的做法进行国家比较有效性研究。我们将实现以下具体目标： 目标1.确定旨在减少急诊室拥挤的医院实践。 目标2.开展一项可靠有效的调查，以衡量医院减少急诊室拥挤的做法。 随后的研究将结合联合收割机最初从全国随机抽样医院收集的调查数据与艾德拥挤措施的公开报告（由医疗保险于2013年初发布），定量分析将评估不同医院实践对艾德拥挤的影响以及患者相关结局，如死亡率和满意度。我们的长期研究计划具有很大的潜力，可以改变组织的护理标准，消除艾德拥挤造成的患者伤害。