Richardson Drew, McMahon Kristin L H
Medical School, Australian National University, Australian Capital Territory, Australia.
Emerg Med Australas. 2009 Aug;21(4):304-8. doi: 10.1111/j.1742-6723.2009.01201.x.
The present study aimed to identify any relationship between existing access block occupancy (ABO) at the time of patient presentation and delay to definitive procedure.
Retrospective descriptive cohort study of all patients aged over 50 years with an ED diagnosis of fractured neck of femur admitted through a tertiary ED over 2 years. The independent variable was the ABO at the start of the hour in which the patient presented, derived from existing ED records, and expressed as the quartile for that hour of the day. The dependent variable was start of surgery more than 24 h after arrival without a documented reason for delay. The data abstractor was blinded to the ABO.
All 442 diagnoses of fractured neck of femur recorded in the ED were reviewed, 73 were excluded (16 age, 5 misdiagnosis, 31 no surgery, 21 documented medical reasons for delay). There was a significant relationship between ABO quartile and the rate of delay to surgery ranging from 54% (95% CI 43-63%) for those presenting in the lowest ABO quartile to 77% (68-85%) in the highest (P= 0.006, chi(2)). Subgroup analysis showed that arrival ABO predicted patient access block, and that patient access block was associated with delay to surgery and longer postoperative length of stay (geometric mean 12.9 vs 9.9 days, P < 0.01, t-test).
The number of access block patients at the time of arrival directly predicts delay to operation in this setting. This suggests that access block occupancy is a marker of hospital dysfunction.
本研究旨在确定患者就诊时现有的通路阻滞占用情况（ABO）与确定性手术延迟之间是否存在关联。
对一家三级急诊科在两年内收治的所有年龄超过50岁且急诊科诊断为股骨颈骨折的患者进行回顾性描述性队列研究。自变量为患者就诊时所在小时开始时的ABO，从现有的急诊科记录中获取，并表示为当天该小时的四分位数。因变量为到达后24小时以上开始手术且无延迟的记录原因。数据提取人员对ABO情况不知情。
对急诊科记录的所有442例股骨颈骨折诊断进行了审查，排除了73例（16例年龄不符、5例误诊、31例未手术、21例有记录的延迟医疗原因）。ABO四分位数与手术延迟率之间存在显著关系，ABO四分位数最低的患者手术延迟率为54%（95%可信区间43 - 63%），最高的为77%（68 - 85%）（P = 0.006，卡方检验）。亚组分析表明，就诊时的ABO可预测患者通路阻滞情况，且患者通路阻滞与手术延迟和术后住院时间延长相关（几何平均数分别为12.9天和9.9天，P < 0.01，t检验）。
在这种情况下，就诊时通路阻滞患者的数量直接预测手术延迟。这表明通路阻滞占用情况是医院功能障碍的一个指标。
