Hillier Debra F, Parry Gareth J, Shannon Michael W, Stack Anne M
Children's Hospital Boston, Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA.
Ann Emerg Med. 2009 Jun;53(6):767-76.e3. doi: 10.1016/j.annemergmed.2008.11.024. Epub 2009 Feb 28.
Although it has been suggested that high hospital occupancy leads to emergency department (ED) overcrowding and impedes ED throughput, there are limited data defining this relationship. The objective of this study is to examine whether high inpatient hospital occupancy negatively affects throughput in a pediatric ED.
This cross-sectional analysis evaluated patient visits to an urban pediatric ED and hospital occupancy rates. Data were collected from a 347-bed pediatric tertiary care hospital in Boston, MA, between January and December 2006. Primary outcome measure was ED length of stay; secondary outcomes were percentages of patients who left without being seen or had a hallway bed used for treatment.
Throughout the study period, there were 56,335 patient visits to the pediatric ED; 9,687 (17%) patients were hospitalized. High hospital occupancy directly correlated with longer length of stay for all patients treated in the ED. When inpatient occupancy was at or more than 80% capacity, every 5% increase in hospital occupancy was associated with an increase in length of stay of 17.7 minutes for discharged patients (95% confidence interval [CI] 2.2 to 33.2 minutes) and 34.3 minutes for admitted patients (95% CI 11.4 to 57.2 minutes). With the same 5% increase in inpatient occupancy, there were increases in the odds of either a patient leaving without being seen (odds ratio 1.21; 95% CI 1.12 to 1.31) or being treated in a hallway bed (odds ratio 1.18; 95% CI 1.15 to 1.22).
High hospital occupancy has a significant and quantifiable negative influence on ED throughput, affecting patients both discharged and hospitalized.
尽管有人认为医院高入住率会导致急诊科拥挤并阻碍急诊科的工作效率，但界定这种关系的数据有限。本研究的目的是检验医院高住院患者入住率是否会对儿科急诊科的工作效率产生负面影响。
本横断面分析评估了城市儿科急诊科的患者就诊情况及医院入住率。数据收集自马萨诸塞州波士顿一家拥有347张床位的儿科三级护理医院，时间为2006年1月至12月。主要结局指标是急诊科留观时间；次要结局指标是未就诊即离开或使用走廊床位进行治疗的患者百分比。
在整个研究期间，儿科急诊科有56335例患者就诊；9687例（17%）患者住院。医院高入住率与急诊科所有接受治疗患者的留观时间延长直接相关。当住院患者入住率达到或超过80%时，医院入住率每增加5%，出院患者的留观时间增加17.7分钟（95%置信区间[CI] 2.2至33.2分钟），入院患者的留观时间增加34.3分钟（95% CI 11.4至57.2分钟）。住院患者入住率同样增加5%时，患者未就诊即离开的几率（优势比1.21；95% CI 1.12至1.31）或在走廊床位接受治疗的几率（优势比1.18；95% CI 1.15至1.22）都会增加。
医院高入住率对急诊科工作效率有显著且可量化的负面影响，对出院患者和住院患者均有影响。
