Adding More Beds to the Emergency Department or Reducing Admitted Patient Boarding Times: Which Has a More Significant Influence on Emergency Department Congestion?
Adding More Beds to the Emergency Department or Reducing Admitted Patient Boarding Times: Which Has a More Significant Influence on Emergency Department Congestion?
复制标题
DOI：
10.1016/j.annemergmed.2008.07.009
复制
发表时间：
2009-05-01
影响因子：
6.2
通讯作者：
Lucenti, Martin
中科院分区：
文献类型：
--
作者：
Khare, Rahul K.;Powell, Emilie S.;Lucenti, Martin
研究目的：我们评估了一个计算机模拟模型，该模型旨在评估改变急诊科床位数量或改变入院患者离开急诊科的时间间隔对急诊科（ED）住院时间的影响。方法：我们基于机构数据创建了一个计算机模拟模型（Med model），并通过专家估计和假设进行了扩充。我们评估了增加急诊科床位数量、增加住院病人离院率和增加急诊科普查的模拟结果，分析了对急诊科总住院时间的潜在影响。多重敏感性分析检验了结果对模型假设和制度数据变化的稳健性。结果：在基本情况下，保持ED离开率不变，增加ED床位，平均住院时间从240分钟增加到247分钟（95%置信区间[CI] 0.8到12.6分钟）。当保持基本情况下的床位数量不变，并增加入院患者离开急诊科到住院床位的比率时，急诊科的平均总住院时间从240分钟减少到218分钟（95% Cl 16.8到26.2分钟）。随着每日人口普查增加15%，趋势与基本情况的结果相似。敏感性分析表明，尽管输入范围很广，但与基本情况没有差异。结论：我们的计算机模拟模型表明，提高住院病人离开急诊科的比率可以改善急诊科的总住院时间，而增加急诊科床位的数量则没有。[j] .中华急诊医学杂志。2009;53:575-585。
Study objective: We evaluate a computer simulation model designed to assess the effect on emergency department (ED) length of stay of varying the number of ED beds or altering the interval of admitted patient departure from the ED.Methods: We created a computer simulation model (Med Model) based on institutional data and augmented by expert estimates and assumptions. We evaluated simulations of increasing the number of ED beds, increasing the admitted patient departure and increasing ED census, analyzing potential effects on overall ED length of stay. Multiple sensitivity analyses tested the robustness of the results to changes in model assumptions and institutional data.Results: With a constant ED departure rate at the base case and increasing ED beds, there is an increase in mean length of stay from 240 to 247 minutes (95% confidence interval [CI] 0.8 to 12.6 minutes). When keeping the number of beds constant at the base case and increasing the rate at which admitted patients depart the ED to their inpatient bed, the mean overall ED length of stay decreases from 240 to 218 minutes (95% Cl 16.8 to 26.2 minutes). With a 15% increase in daily census, the trends are similar to the base case results. The sensitivity analyses reveal that despite a wide range of inputs, there are no differences from the base case.Conclusion: Our computer simulation modeled that improving the rate at which admitted patients depart the ED produced an improvement in overall ED length of stay, whereas increasing the number of ED beds did not. [Ann Emerg Med. 2009;53:575-585.]