Sprivulis Peter
Department of Emergency Medicine, Fremantle Hospital, Fremantle, Western Australia, Australia.
Emerg Med (Fremantle). 2003 Feb;15(1):32-7. doi: 10.1046/j.1442-2026.2003.00405.x.
A transparent and easily replicated method of estimating the number of, and costs associated with, low acuity presentations to an emergency department is required to assist evaluation of the utilization of emergency department services. This study presents two independent estimates of the number of, and costs associated with, low acuity presentations to an emergency department.
A retrospective analysis was conducted using emergency department information system data from a metropolitan mixed paediatric/adult teaching hospital emergency department/trauma centre. Low acuity patient presentation estimates were calculated by: Method one: The product of (A) total self-referred presentations for triage categories three, four and five and (B) the difference between the self-referred and general practitioner-referred discharge rates from the emergency department. Total low acuity patient presentations = (A x B). Method two: Summing the number of self-referrals with presenting problems never referred by general practitioners. Costs were calculated using Commonwealth cost weights.
Method one gave a low acuity patient estimate of 12.5% (95% CI 12.0-13.0%) and method two 10.6% (95% CI 10.2-11.0%) of total presentations. Costs were 10.5% (method one) and 8.5% (method two) of total costs. Adjusted for assessment time, costs were 6.8% (method one) and 5.5% (method two) of total costs. Low acuity patients were more common outside of normal working hours, method one: 14.4% (95% CI 13.5-15.2%) versus 10.0% (95% CI 9.4-10.6%), P < 0.001; method two: 11.4% (95% CI 10.9-12.0%) versus 8.5% (95% CI 7.8-9.2%), P < 0.001. Provision of alternative daily 0900-2400 general practice services would change low acuity patients by no more than 2-3% of total presentations and change low acuity patient costs by no more than 2% of total costs.
Low acuity patients form a small, relatively constant part of the emergency department workload. The provision of alternative after-hours services for low acuity patients would be unlikely to significantly reduce the overall work load of this metropolitan emergency department.
需要一种透明且易于复制的方法来估算急诊科低 acuity 就诊的数量及相关成本，以协助评估急诊科服务的利用情况。本研究给出了两种独立的急诊科低 acuity 就诊数量及相关成本的估算。
使用来自一家大都市儿科/成人混合教学医院急诊科/创伤中心的急诊科信息系统数据进行回顾性分析。低 acuity 患者就诊估算通过以下方式计算：方法一：（A）分诊类别三、四和五的总自行就诊数与（B）急诊科自行就诊和全科医生转诊出院率之差的乘积。低 acuity 患者总就诊数 =（A×B）。方法二：将自行就诊且存在全科医生从未转诊过的问题的数量相加。成本使用联邦成本权重计算。
方法一得出低 acuity 患者占总就诊数的 12.5%（95%置信区间 12.0 - 13.0%），方法二为 10.6%（95%置信区间 10.2 - 11.0%）。成本分别为总成本的 10.5%（方法一）和 8.5%（方法二）。经评估时间调整后，成本分别为总成本的 6.8%（方法一）和 5.5%（方法二）。低 acuity 患者在正常工作时间之外更为常见，方法一：14.4%（95%置信区间 13.5 - 15.2%）对 10.0%（95%置信区间 9.4 - 10.6%），P < 0.001；方法二：11.4%（95%置信区间 10.9 - 12.0%）对 8.5%（95%置信区间 7.8 - 9.2%），P < 0.001。提供替代每日 09:00 - 24:00 的全科医疗服务对低 acuity 患者就诊数的改变不超过总就诊数的 2 - 3%，对低 acuity 患者成本的改变不超过总成本的 2%。
低 acuity 患者占急诊科工作量的一小部分且相对稳定。为低 acuity 患者提供替代的非工作时间服务不太可能显著降低这家大都市急诊科的总体工作量。
