Pines Jesse M, Garson Chad, Baxt William G, Rhodes Karin V, Shofer Frances S, Hollander Judd E
Department of Emergency Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Acad Emerg Med. 2007 Dec;14(12):1176-81. doi: 10.1197/j.aem.2007.06.043.
The authors measured the association between emergency department (ED) crowding and patient and provider perceptions about whether patient care was compromised.
This was a cross-sectional study of patients admitted from the ED and their providers. Surveys of patients, nurses, and resident physicians were linked. The primary outcome was agreement or strong agreement on a five-item scale assessing whether ED crowding compromised care. Logistic regression was used to determine the association between the primary outcome and measures of ED crowding.
Of 741 patients approached, 644 patients consented (87%); 703 resident physician surveys (95%) and 716 nursing surveys (97%) were completed. A total of 106 patients (16%), 86 residents (12%), and 173 nurses (24%) reported that care was compromised by ED crowding. In 252 cases (35%), one or more respondents reported that care was compromised. There was poor agreement over whose care was compromised. For patients, independent predictors of compromised care were waiting room time (odds ratio [OR], 1.05 for each additional 10-minute wait [95% confidence interval {CI} = 1.02 to 1.09]) and being surveyed in a hallway bed (OR, 2.02 [95% CI = 1.12 to 3.68]). Predictors of compromised care for nurses included waiting room time (OR, 1.05 for each additional 10-minute wait [95% CI = 1.01 to 1.08]), number of patients in the waiting room (OR, 1.05 for each additional patient waiting [95% CI = 1.02 to 1.07]), and number of admitted patients waiting for an inpatient bed (OR, 1.08 for each additional patient [95% CI = 1.03 to 1.12]). For residents, predictors of compromised care were patient/nurse ratio (OR, 1.39 for a one-unit increase [95% CI = 1.09 to 1.20]) and number of admitted patients waiting for an inpatient bed (OR, 1.14 for each additional patient [95% CI = 1.10 to 1.75]).
ED crowding is associated with perceptions of compromised emergency care. There is considerable variability among nurses, patients, and resident physicians over which factors are associated with compromised care, whose care was compromised, and how care was compromised.
作者测量了急诊科拥挤与患者及医护人员对于患者护理是否受到影响的看法之间的关联。
这是一项对从急诊科收治的患者及其医护人员的横断面研究。对患者、护士和住院医师的调查相互关联。主要结局是在一个五项量表上达成一致或强烈一致，该量表用于评估急诊科拥挤是否影响护理。采用逻辑回归来确定主要结局与急诊科拥挤指标之间的关联。
在接触的741名患者中，644名患者同意参与（87%）；完成了703份住院医师调查问卷（95%）和716份护士调查问卷（97%）。共有106名患者（16%）、86名住院医师（12%）和173名护士（24%）报告称护理受到急诊科拥挤的影响。在252例病例（35%）中，一名或多名受访者报告护理受到影响。对于护理受到影响的患者身份，各方意见分歧较大。对于患者而言，护理受影响的独立预测因素包括候诊时间（比值比[OR]，每多等待10分钟为1.05[95%置信区间{CI}=1.02至1.09]）以及在走廊病床接受调查（OR，2.02[95%CI=1.12至3.68]）。护士认为护理受影响的预测因素包括候诊时间（OR，每多等待10分钟为1.05[95%CI=1.01至1.08]）、候诊室患者数量（OR，每多一名候诊患者为1.05[95%CI=1.02至1.07]）以及等待住院床位的入院患者数量（OR，每多一名患者为1.08[95%CI=1.03至1.12]）。对于住院医师而言，护理受影响的预测因素是患者/护士比例（OR，每增加一个单位为1.39[95%CI=1.09至1.20]）以及等待住院床位的入院患者数量（OR，每多一名患者为1.14[95%CI=1.10至1.75]）。
急诊科拥挤与对急诊护理受影响的看法相关。在哪些因素与护理受影响相关、哪些患者的护理受影响以及护理如何受影响等问题上，护士、患者和住院医师之间存在相当大的差异。
