Effects of Emergency Department Crowding on Patient Safety

描述（由申请人提供）：在过去十年中，急诊室（艾德）拥挤已成为一个主要的公共卫生危机。艾德拥挤从根本上说是一个患者安全问题，与艾德拥挤相关的延迟可能会对急性疾病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艾德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证明艾德拥挤对患者水平安全性结局的影响，例如艾德中的死亡、艾德出院后的死亡和入院后的死亡。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。 为了评估艾德拥挤对患者安全的影响，研究人员将对Kaiser Permanente Southern加州（KPSC）（一个区域综合卫生系统）内2007年所有艾德就诊进行回顾性队列研究。该分析将包括KPSC成员患者到11家KPSC医院的650，000次艾德访视。将使用访视特定的拥挤暴露（等待、治疗和登机时间）来测量与每次就诊相关的艾德拥挤。本研究的具体目的如下：1。评估急诊室拥挤与急诊室死亡之间的关系。2.评估急诊室拥挤与急诊室出院后的门诊结果之间的关系，包括7天的反弹住院和死亡。3.评估急诊室拥挤与住院后结局之间的关系，包括住院时间、住院死亡和30天死亡。 本申请的结果将用于设计未来的艾德患者安全性研究。本研究计划的长期目标是设计和评估卫生系统干预措施，以减轻艾德拥挤对患者安全的影响。 公共卫生相关性：急诊室拥挤是一种影响急性护理系统的全国性现象。该应用程序将评估急诊科拥挤对患者安全结局的访问级别暴露的影响，包括急诊科，住院和门诊环境中的死亡。

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.