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会已确定急诊科 (ED) 拥挤是对公共安全的严重威胁。暴露在危险拥挤的急诊室条件下，短期死亡率相对风险增加 30-80%，并导致护理及时性下降、患者满意度降低以及医疗保健获取方面的差异。然而，有效的策略可以减少 尽管进行了十年的运筹学研究，急诊室拥挤情况仍然不明确。 我们研究计划的长期目标是消除与急诊室拥挤相关的患者伤害。为了解决现有文献的局限性，我们提出了一项假设生成研究，以识别、分类和衡量医院的做法，以减少急诊室拥挤。我们的定性研究计划将研究不同绩效水平的医院的自然实验。该项目将与 ED 基准联盟 (EDBA) 合作执行，该联盟是由 800 多家医院组成的独特合作组织，收集标准化的 ED 拥挤数据。该提案将创建工具来对医院实践进行全国比较有效性研究，以减少急诊室拥挤。我们将实现以下具体目标： 目标 1. 确定旨在减少急诊科拥挤的医院做法。 目标 2. 开展可靠且有效的调查来衡量医院旨在减少急诊室拥挤的做法。 后续研究将把最初收集的全国医院随机样本调查数据与急诊室拥挤措施绩效公开报告（Medicare 于 2013 年初发布）结合起来~定量分析将评估不同医院做法对急诊室拥挤情况以及患者相关结果（如死亡率和满意度）的影响。我们的长期研究计划很有可能改变组织的护理标准并消除急诊室拥挤造成的患者伤害。