Schafermeyer Robert W, Asplin Brent R
Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA.
Emerg Med (Fremantle). 2003 Feb;15(1):22-7. doi: 10.1046/j.1442-2026.2003.00403.x.
Every emergency physician in the United States and, for that matter, in many countries around the world recognizes that the demand for timely access to quality emergency care is one that patients highly value. Unfortunately, hospitals in the USA have become stretched beyond capacity, resulting in overloaded emergency departments, diverted ambulances, and greater risks for patients and providers. Some of the causes and consequences of emergency department crowding are unique to the USA health care system, while others are common to countries throughout the world. The goals for this paper are to provide a brief overview of hospital and emergency department crowding in the USA, to identify commonly cited causes of the problem, and to outline future directions in the search for solutions. A large number of hospitals, inpatient beds, and emergency departments have closed during the past 10 years in the USA. In 1992 there were around 6000 hospitals with emergency departments and there are now less than 4000. While hospitals scrambled to decrease an excess supply of inpatient beds, the demand for emergency department care steadily rose. Between 1992 and 2000, the annual number of emergency department visits in the USA increased from 89.8 to 108 million. While some areas of the USA have been affected more seriously than others (particularly the coasts), almost every state has reported problems with boarding of inpatients in the emergency department. Inpatient boarding is the most frequently cited reason for emergency department crowding within the emergency medicine community. United States hospitals are also struggling with a shortage of health care professionals, particularly registered nurses. There are several policy issues that must be addressed to alleviate hospital and emergency department crowding over the long term. We list these as 'long-term' goals simply because policy changes, in the USA, are often incremental and rarely occur quickly. In order to achieve any of these changes in policy over the long term, advocates for reform must aggressively pursue them today.
美国的每一位急诊医生，事实上世界上许多国家的急诊医生都认识到，及时获得高质量急诊护理的需求是患者高度重视的。不幸的是，美国的医院已不堪重负，导致急诊科人满为患、救护车改道，给患者和医护人员带来更大风险。急诊科拥挤的一些原因和后果是美国医疗保健系统所特有的，而其他一些则是世界各国普遍存在的。本文的目的是简要概述美国医院和急诊科的拥挤情况，找出该问题常见的原因，并概述寻求解决方案的未来方向。在过去10年里，美国大量的医院、住院床位和急诊科关闭。1992年，约有6000家设有急诊科的医院，如今已不到4000家。当医院忙于减少住院床位的过剩供应时，对急诊科护理的需求却稳步上升。1992年至2000年期间，美国急诊科的年就诊人数从8980万增加到1.08亿。虽然美国的一些地区比其他地区受到的影响更严重（特别是沿海地区），但几乎每个州都报告了急诊科住院患者滞留的问题。住院患者滞留是急诊医学界最常提到的急诊科拥挤的原因。美国医院还面临着医疗保健专业人员短缺的问题，尤其是注册护士。为了长期缓解医院和急诊科的拥挤状况，必须解决几个政策问题。我们将这些列为“长期”目标，仅仅是因为在美国，政策变化往往是渐进的，很少迅速发生。为了长期实现这些政策变化中的任何一项，改革倡导者今天就必须积极推进。
