Gómez-Vaquero C, Soler A Salazar, Pastor A Juan, Mas J R Perez, Rodriguez J Jacob, Virós X Corbella
Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet, Barcelona, Spain.
Emerg Med J. 2009 Aug;26(8):571-2. doi: 10.1136/emj.2008.066076.
Access block, the inability of patients in the emergency department (ED) to access hospital beds, is a contributing factor to overcrowding in the ED. The effect of a holding unit (HU) on access block and some medical management indicators is presented.
In October 2002 an HU was opened with 16 beds for patients coming from the ED. Every morning all the patients are moved from the HU to a conventional unit; if there are not enough unoccupied beds, elective admissions are cancelled. For the previous and subsequent years after the opening of the HU, the following factors were analysed: (1) number of patients visiting the ED; (2) number of urgent admissions; (3) length of stay in the ED; (4) number of patients waiting for an in-hospital bed in the ED at 08.00 h; (5) number of elective admissions; and (6) number of cancelled elective admissions.
Although there was an increase of 3.1% in the number of patients visiting the ED during the first year following the opening of the HU compared with the previous year, the number and percentage of urgent admissions remained unchanged. In the same period the mean number of patients waiting for a bed in the ED decreased by 55.6% (9.1 vs 4.0 patients per day). However, the mean length of stay in the ED increased by 6.9% (p<0.001). The number and percentage of cancelled elective admissions were similar in the two periods of the study.
The opening of an HU has led to an improvement in the access block.
急诊室准入障碍，即急诊科患者无法使用医院病床，是导致急诊科过度拥挤的一个因素。本文介绍了一个暂留单元（HU）对准入障碍及一些医疗管理指标的影响。
2002年10月开设了一个拥有16张床位的暂留单元，用于收治来自急诊科的患者。每天早晨，所有患者都从暂留单元转至传统病房；如果没有足够的空床位，则取消择期入院。对暂留单元开放前后的年份，分析了以下因素：（1）急诊科就诊患者数量；（2）紧急入院患者数量；（3）在急诊科的住院时间；（4）8点时急诊科等待住院床位的患者数量；（5）择期入院患者数量；（6）取消的择期入院患者数量。
与前一年相比，暂留单元开放后的第一年，急诊科就诊患者数量增加了3.1%，但紧急入院患者的数量和比例保持不变。同期，急诊科等待床位的患者平均数量减少了55.6%（从每天9.1例降至4.0例）。然而，急诊科的平均住院时间增加了6.9%（p<0.001）。研究的两个阶段中，取消的择期入院患者数量和比例相似。
暂留单元的开放改善了准入障碍。
