Mahajan Prashant, Thomas Ronald, Rosenberg David R, Leleszi Jimmie P, Leleszi Elizabeth, Mathur Ambika, Hairston Elese L, Knazik Stephen R
Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI 48201, USA.
Pediatr Emerg Care. 2007 Apr;23(4):212-7. doi: 10.1097/PEC.0b013e31803e177f.
To address a rising trend of emergency department (ED) visits for mental disorders (VMD), our ED implemented a child guidance model for their efficient evaluation and disposition.
The main objective of our study was to evaluate the impact of the child guidance model on the ED length of stay (LOS) and ED costs on children with VMD.
We conducted a retrospective chart analysis on 1031 VMD visits made to an inner-city tertiary care pediatric ED in 2002 (1.4% of the total 2002 ED visits). We collected demographic and LOS information on all VMD visits. The child guidance model was implemented June 2002, after which we divided the VMD cases into 2 groups based on the presence or absence of the model. We performed a cost analysis to assess the impact of the model on LOS and determined the opportunity costs of prolonged LOS of the VMD visits as compared with 500 non-VMD visits.
The average LOS of VMD visits was longer than that of the 500 non-VMD visits (236.04 minutes +/- 162.82 vs. 134.69 minutes +/- 95.19; mean difference, 101.34 minutes; P = 0.001). The LOS was significantly reduced after the model was implemented (259.49 minutes +/- 171.12 vs. 216.39 +/- 152.95 minutes, P = 0.00). The lost revenue due to extended VMD LOS was calculated as opportunity costs of $201,173.30, whereas the cost savings during the study period due to reduced LOS after the model was implemented was $10,651.
This study suggests that children with VMD visits contribute a substantial resource burden in the ED, and focused interventions such as the child guidance model in the ED can significantly decrease LOS and reduce ED costs.
为应对精神障碍患者急诊就诊人数上升的趋势，我们的急诊科实施了一种儿童指导模式，以实现对这些患者的高效评估和处置。
本研究的主要目的是评估儿童指导模式对精神障碍患儿急诊留观时间（LOS）和急诊费用的影响。
我们对2002年一家市中心三级护理儿科急诊科的1031例精神障碍患者就诊情况进行了回顾性病历分析（占2002年急诊科总就诊人数的1.4%）。我们收集了所有精神障碍患者就诊的人口统计学和留观时间信息。儿童指导模式于2002年6月实施，之后我们根据是否采用该模式将精神障碍病例分为两组。我们进行了成本分析，以评估该模式对留观时间的影响，并确定与500例非精神障碍患者就诊相比，精神障碍患者就诊延长留观时间的机会成本。
精神障碍患者就诊的平均留观时间长于500例非精神障碍患者就诊（236.04分钟±162.82分钟 vs. 134.69分钟±95.19分钟；平均差异为101.34分钟；P = 0.001）。该模式实施后留观时间显著缩短（259.49分钟±171.12分钟 vs. 216.39±152.95分钟，P = 0.00）。因精神障碍患者留观时间延长导致的收入损失计算为机会成本201,173.30美元，而该模式实施后因留观时间缩短在研究期间节省的成本为10,651美元。
本研究表明，精神障碍患者就诊给急诊科带来了巨大的资源负担，而急诊科采用儿童指导模式等针对性干预措施可显著缩短留观时间并降低急诊费用。
