Effects of Emergency Department Crowding on Patient Safety

急诊科拥挤对患者安全的影响

• 批准号: 7957671
• 负责人: Gelareh Z. Gabayan
• 金额: $ 10万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7957671
• 关键词: Effects; Emergency; Department; Crowding; Patient

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.

描述(由申请人提供)：在过去的十年里，急诊科(ED)的拥挤已经成为一种主要的公共卫生危机。急诊室拥挤从根本上说是一个患者安全问题，与急诊室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数据表明急诊室拥挤对患者水平的安全结果的影响，如急诊室死亡、急诊室出院后死亡和入院后死亡。如果没有这样的证据，政策制定者不太可能投入大量资源来解决教育拥挤的根本原因。为了评估急诊室拥挤对患者安全的影响，调查人员将对南加州凯撒永久医疗中心(KPSC)2007年的所有急诊室就诊进行回顾性队列研究，KPSC是一个地区性综合医疗系统。这项分析将包括KPSC成员患者对11家KPSC医院的650,000次急诊。与每次相遇相关的急诊拥挤将使用特定于来访的拥挤暴露(等待、治疗和登机时间)来衡量。本研究有以下具体目的：1.评估急诊科拥挤与死亡的关系。2.评估急诊科拥挤与急诊科出院后7天反弹住院和死亡之间的关系。3.评估急诊科拥挤与住院后结局的关系，包括住院时间、住院死亡和30天死亡。这项应用的结果将用于设计未来对ED患者安全性的研究。这项研究计划的长期目标是设计和评估卫生系统干预措施，以减轻急诊室拥挤对患者安全的影响。 公共卫生相关性：急诊科拥挤是影响急诊护理系统的全国性现象。该应用程序将评估急诊科拥挤的就诊级别暴露对患者安全结果的影响，包括急诊科、住院患者和门诊设置中的死亡。