Effects of Emergency Department Crowding on Patient Safety

描述（由申请人提供）：在过去的十年里，急诊科（ED）拥挤已成为一个重大的公共卫生危机。急诊科拥挤从根本上是一个患者安全问题，与急诊科拥挤相关的延误可能会对急症患者的护理产生不利影响。然而，政策制定者和卫生系统领导人未能将ED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证明急诊科拥挤对患者安全结果（如急诊科死亡、急诊科出院后死亡和住院后死亡）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对患者安全的影响，研究人员将对南加州凯撒医疗机构（KPSC） 2007年所有急诊科就诊进行回顾性队列研究，这是一个区域性综合卫生系统。该分析将包括KPSC成员患者到11家KPSC医院的65万次急诊科就诊。与每次就诊相关的急诊科拥挤情况将使用就诊特定的拥挤暴露（等待、治疗和登机时间）来测量。本研究的具体目的如下：1。评估急诊科拥挤与急诊科死亡之间的关系。2. 评估急诊科拥挤与急诊科出院后门诊结果的关系，包括7天回弹住院和死亡。3. 评估急诊科拥挤程度与住院后结局（包括住院时间、院内死亡和30天死亡）之间的关系。这项应用的结果将用于设计ED患者安全的未来研究。本研究计划的长期目标是设计和评估卫生系统干预措施，以减轻急诊科拥挤对患者安全的影响。

DESCRIPTION (provided by applicant): Emergency department (ED) crowding has become a major public health crisis over the past decade. ED crowding is fundamentally a patient safety issue, and delays associated with ED crowding may adversely impact the care of patients with acute illnesses. However, policymakers and health system leaders have failed to address ED crowding as a top public health priority. The primary reason for inaction is the paucity of data demonstrating the impact of ED crowding on patient-level safety outcomes, such as deaths in the ED, deaths after ED discharge, and deaths after hospital admission. Without such evidence, policymakers are unlikely to commit substantial resources to address the root causes of ED crowding. To assess the impact of ED crowding on patient safety, investigators will perform a retrospective cohort study of all 2007 ED visits within Kaiser Permanente Southern California (KPSC), which is a regional integrated health system. This analysis will include 650,000 ED visits by KPSC member patients to 11 KPSC hospitals. ED crowding associated with each encounter will be measured using visit-specific exposures to crowding (waiting, treatment, and boarding times). This study has the following Specific Aims: 1. Assess the relationship between emergency department crowding and death in the emergency department. 2. Assess the relationship between emergency department crowding and outpatient outcomes after emergency department discharge, including 7-day bounce back hospitalization and death. 3. Assess the relationship between emergency department crowding and outcomes after hospitalization, including length-of-stay, in-hospital death, and 30-day death. The findings from this application will be used to design future studies of ED patient safety. The long- term goal of this research program is to design and evaluate health systems interventions to mitigate the impacts of ED crowding on patient safety. PUBLIC HEALTH RELEVANCE: Emergency department crowding is a nationwide phenomenon affecting the acute care system. This application will assess the impact of visit-level exposures of emergency department crowding on patient safety outcomes, including death in the emergency department, inpatient, and outpatient settings.