Eckstein Marc, Isaacs S Marshal, Slovis Corey M, Kaufman Bradley J, Loflin James R, O'Connor Robert E, Pepe Paul E
Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, USA.
Prehosp Emerg Care. 2005 Jul-Sep;9(3):267-75. doi: 10.1080/10903120590962102.
The escalating national problem of oversaturated hospital beds and emergency departments (EDs) has resulted in serious operational impediments within patient-receiving facilities. It has also had a growing impact on the 9-1-1 emergency care system. Beyond the long-standing difficulties arising from ambulance diversion practices, many emergency medical services (EMS) crews are now finding themselves detained in EDs for protracted periods, unable to transfer care of their transported patients to ED staff members. Key factors have included a lack of beds or stretcher space, and, in some cases, EMS personnel are used transiently for ED patient care services. In other circumstances, ED staff members no longer prioritize rapid turnaround of EMS-transported patients because of the increasing volume and acuity of patients already in their care. The resulting detention of EMS crews confounds concurrent ambulance availability problems, creates concrete risks for delayed EMS responses to impending critical cases, and incurs regulatory jeopardy for hospitals. Communities should take appropriate steps to ensure that delivery intervals (time elapsing from entry into the hospital to physical transfer of patient care to ED staff) remain extremely brief (less than a few minutes) and that they rarely exceed 10 minutes. While recognizing that the root causes of these issues will require far-reaching national health care policy changes, EMS and local government officials should still maintain ongoing dialogues with hospital chief administrators to mitigate this mutual crisis of escalating service demands. Federal and state health officials should also play an active role in monitoring progress and compliance.
医院病床和急诊科过度饱和这一日益严重的全国性问题，已给患者接收机构带来了严重的运营障碍。它对911紧急护理系统的影响也在不断增大。除了救护车分流做法长期存在的困难之外，许多紧急医疗服务（EMS）人员现在发现自己在急诊科被长时间滞留，无法将所运送患者的护理工作移交给急诊科工作人员。关键因素包括床位或担架空间不足，而且在某些情况下，EMS人员被临时用于急诊科患者护理服务。在其他情况下，由于急诊科已经在护理的患者数量增加且病情加重，急诊科工作人员不再将快速周转EMS运送的患者作为优先事项。EMS人员的滞留导致了同时出现的救护车可用性问题，给对即将出现的危急病例的EMS延迟响应带来了切实风险，并使医院面临监管风险。社区应采取适当措施，确保交接间隔时间（从进入医院到将患者护理实际移交给急诊科工作人员所经过的时间）保持极短（少于几分钟），且很少超过10分钟。虽然认识到这些问题的根本原因需要深远的国家医疗保健政策变革，但EMS和地方政府官员仍应与医院首席行政官保持持续对话，以缓解这种服务需求不断升级的共同危机。联邦和州卫生官员也应积极参与监督进展情况和合规情况。
