Emergency Department Crowding: Community Determinants and Patient Outcomes

描述（由申请人提供）：急诊科（艾德）拥挤已使急诊护理系统紧张到了崩溃的地步。艾德拥挤的两个最明显的症状，救护车分流和“在被看到之前离开”的就诊率，随着时间的推移急剧增加，现在在许多城市中心已经司空见惯。艾德拥挤导致评估和治疗延迟，这反过来可能导致不良结果。因此，美国急诊医师学会已经将艾德拥挤确定为威胁急诊护理安全和质量的首要问题之一。 然而，政策制定者和卫生系统领导人未能将急诊室拥挤问题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关于艾德拥挤的社区差异以及艾德拥挤对患者结局的影响的数据。没有这些证据，决策者不太可能投入大量资源来解决艾德拥挤的根本原因。 为了评估艾德拥挤的模式和结果，我们提出了一个回顾性队列研究的所有2007年艾德访问非联邦，加州医院。该分析将包括来自342个加州ED的880万例出院和150万例住院。我们会以每日救护车分流时间和“未就诊先离开”的探访率作为衡量艾德院挤迫程度的指标。本研究的具体目的如下： 1.确定社区水平的急诊室拥挤的预测因素。 2.评估急诊室拥挤与急诊室出院后7天反弹住院之间的关系。 3.评估急诊室拥挤与住院结局之间的关系，包括死亡、住院时间和费用。 加州占美国所有艾德就诊人数的近10%，代表了患者人群和医院系统的多样性。因此，拟议的研究将提供普遍的见解，这一卫生政策危机。

DESCRIPTION (provided by the applicant): Emergency department (ED) crowding has strained the acute care system to its breaking point. Two of the most visible symptoms of ED crowding, ambulance diversion and 'left before being seen' visit rates, have dramatically increased over time and are now routine in many urban centers. ED crowding causes delays in evaluation and treatment, which in turn may contribute to adverse outcomes. Consequently, the American College of Emergency Physicians has identified ED crowding as one of the top problems threatening the safety and quality of emergency care. However, policymakers and health system leaders have failed to address emergency department crowding as a top public health priority. The primary reason for inaction is the paucity of data on community disparities in ED crowding and the impact of ED crowding on patient outcomes. Without such evidence, policymakers are unlikely to commit substantial resources to address root causes of ED crowding. In order to assess patterns and outcomes of ED crowding, we propose a retrospective cohort study of all 2007 ED visits to non-federal, California hospitals. This analysis will include 8.8 million discharges and 1.5 million hospitalizations from 342 California EDs. We will use daily ambulance diversion hours and 'left before being seen' (LBBS) visit rates as measures of ED crowding. This study has the following Specific Aims: 1. Identify community level predictors of emergency department crowding. 2. Assess the relationship between emergency department crowding and 7-day bounce-back hospitalizations after emergency department discharge. 3. Assess the relationship between emergency department crowding and inpatient outcomes, including death, length-of-stay, and costs. California accounts for nearly 10% of all ED visits in the United States and represents a diversity of patient populations and hospital systems. Therefore, the proposed study will provide generalizable insights into this health policy crisis.