Singer Adam J, Viccellio Peter, Thode Henry C, Bock Jay L, Henry Mark C
Department of Emergency Medicine, Stony Brook University, Stony Brook, NY, USA.
Acad Emerg Med. 2008 Apr;15(4):324-8. doi: 10.1111/j.1553-2712.2008.00065.x.
Emergency department (ED) length of stay (LOS) impacts patient satisfaction and overcrowding. Laboratory turnaround time (TAT) is a major determinant of ED LOS. The authors determined the impact of a Stat laboratory (Stat lab) on ED LOS. The authors hypothesized that a Stat lab would reduce ED LOS for admitted patients by 1 hour.
This was a before-and-after study conducted at an academic suburban ED with 75,000 annual patient visits. All patients presenting to the ED during the months of August and October 2006 were considered. A Stat lab located within the central laboratory was introduced in September 2006 to reduce laboratory TAT. The test TATs and ED LOS before (August 2006) and after (October 2006) implementing the Stat lab for all ED patients were the data of interest. ED LOS before and after the Stat lab was introduced was compared with the Mann-Whitney U-test. A sample size of 5,000 patients in each group had 99% power to detect a 1-hour difference in ED LOS.
There were 5,631 ED visits before and 5,635 visits after implementing the Stat lab. Groups were similar in age (34 years vs. 36 years) and gender (51% males in both). The percentages of patients with laboratory tests before and after Stat lab implementation were 68.7 and 71.3%, respectively. Test TATs for admitted patients were significantly improved after the Stat lab introduction. Implementation of the Stat lab was associated with a significant reduction in the median ED LOS from 466 (interquartile range [IQR] = minutes before to 402 (IQR = 296-553) minutes after implementing the Stat lab. The effects of the Stat lab on ED LOS were less marked for discharged patients.
Introduction of a Stat lab dedicated to the ED within the central laboratory was associated with shorter laboratory TATs and shorter ED LOS for admitted patients, by approximately 1 hour.
急诊科（ED）的住院时间（LOS）会影响患者满意度和过度拥挤情况。实验室周转时间（TAT）是ED住院时间的一个主要决定因素。作者确定了一个即时检验实验室（Stat实验室）对ED住院时间的影响。作者假设一个Stat实验室将使入院患者的ED住院时间缩短1小时。
这是一项在一家每年有75000例患者就诊的郊区学术性急诊科进行的前后对照研究。纳入了2006年8月和10月期间到该急诊科就诊的所有患者。2006年9月在中心实验室内设立了一个Stat实验室，以缩短实验室TAT。2006年8月（实施Stat实验室之前）和10月（实施Stat实验室之后）所有ED患者的检验TAT和ED住院时间是研究的关注数据。采用Mann-Whitney U检验比较引入Stat实验室前后的ED住院时间。每组5000例患者的样本量有99%的把握度检测出ED住院时间1小时的差异。
实施Stat实验室之前有5631例ED就诊，之后有5635例就诊。两组在年龄（34岁对36岁）和性别（两组男性均占51%）方面相似。实施Stat实验室前后进行实验室检查的患者百分比分别为68.7%和71.3%。引入Stat实验室后，入院患者的检验TAT有显著改善。Stat实验室的实施与ED住院时间中位数从466分钟（四分位间距[IQR]=实施Stat实验室之前）显著缩短至402分钟（IQR=296 - 553）分钟（实施Stat实验室之后）相关。Stat实验室对出院患者的ED住院时间影响较小。
在中心实验室内设立一个专门针对ED的Stat实验室与缩短实验室TAT以及使入院患者的ED住院时间缩短约1小时相关。
