Richards Michael E, Hubble Michael W, Crandall Cameron
Department of Emergency Medicine, University of New Mexico, Albuquerque, NM 87131-0001, USA.
Prehosp Emerg Care. 2006 Oct-Dec;10(4):440-6. doi: 10.1080/10903120600725868.
For a limited number of presenting complaints, arrival by ambulance has been shown in some emergency departments to decrease time to be seen by a physician. We sought to determine if this time advantage could be demonstrated as a national trend over a variety of presenting complaints.
A secondary analysis was performed on the National Hospital Ambulatory Medical Care Survey, a national probability sample of emergency department visits. To compare waiting times between patients arriving by ambulance and those arriving by walk-in, a survival analysis was performed using univariate and multivariate Cox proportional hazards models. Primary variables of interest were mode of arrival, waiting time to see physician, and immediacy to be seen (triage category). The weighted values were utilized to produce national estimates. Patients who left without being seen were treated as right censored data.
A total of 61,130 records, weighted to represent 268.3 million emergency department visits from 1997 to 2000, were included in the analysis. Patients arrived by ambulance in 14.4% of these cases. Median wait time for patients arriving by ambulance was 14.1 minutes (95% confidence interval [CI], 4.3 to 34.2) as compared with 26.0 minutes (95% CI, 11.5 to 55.1) for patients who arrived by walk-in. In the multivariate analysis, arrival by ambulance offered a 25.0% (95% CI, 19.0% to 31.6%) time advantage over walk-in and a 40.8% (95% CI, 23.5% to 58.7%) time advantage over arrival by public service.
Arrival by ambulance offered a time to be seen advantage for a broad range of presenting complaints in the National Hospital Ambulatory Medical Care Survey across all triage categories.
在一些急诊科，对于少数就诊主诉，已表明救护车送达可缩短患者等待医生诊疗的时间。我们试图确定这种时间优势是否能作为各种就诊主诉的全国性趋势得到证实。
对国家医院门诊医疗调查进行了二次分析，该调查是对急诊科就诊情况的全国概率抽样。为比较救护车送达患者与步行就诊患者的等待时间，使用单变量和多变量Cox比例风险模型进行了生存分析。主要关注变量为到达方式、等待医生诊疗时间以及即刻诊疗情况（分诊类别）。利用加权值得出全国估计数。未就诊即离开的患者被视为截尾数据。
分析纳入了总共61130条记录，加权后代表1997年至2000年的2.683亿次急诊科就诊。其中14.4%的病例患者由救护车送达。救护车送达患者的中位等待时间为14.1分钟（95%置信区间[CI]，4.3至34.2），而步行就诊患者的中位等待时间为26.0分钟（95%CI，11.5至55.1）。在多变量分析中，与步行就诊相比，救护车送达具有25.0%（95%CI，19.0%至31.6%）的时间优势，与公共服务送达相比具有40.8%（95%CI，23.5%至58.7%）的时间优势。
在国家医院门诊医疗调查中，救护车送达在所有分诊类别下对于广泛的就诊主诉都具有等待诊疗时间优势。
