Australian National University Medical School, Canberra, New South Wales, Australia.
Emerg Med Australas. 2009 Dec;21(6):472-8. doi: 10.1111/j.1742-6723.2009.01241.x.
Access block is the inability of ED patients requiring admission to access appropriate inpatient beds in a timely fashion, defined in Australasia as more than 8 h in the ED. The present study describes changes in prevalence of access block in Australia over a 4 year period.
Email, telephone and fax survey of ED on six Mondays at 10.00 hours (31 May, 30 August 2004, 18 June, 3 September 2007, 2 June, 2 September 2008). Data collected included point data on the status of patients in the ED at the index time and of recent ED attendance numbers. Results were collated and analysed by state and hospital role delineation.
Forty-eight (60%) of 80 eligible ED answered all six surveys. Presentations to the ED the day before rose 15% (P < 0.0001, paired t-test) in 4 years, and nationally access block patients in the ED rose an average of 27%, and patients waiting to be seen by a doctor 31%. There were differences between states, with hospitals in New South Wales reporting a significant reduction in access block patients (-51%, P= 0.0002), but all other states a significant increase (+45%, P= 0.001). There were differences by role delineation, with non-paediatric major referral hospitals experiencing the greatest access block, but smaller hospitals experiencing the greatest increase in patients waiting.
Around one-third of all patients receiving care in these ED surveys were experiencing access block. There is evidence that flow through New South Wales ED has improved. The data suggest that most hospitals have passed the point of efficiency.
急诊患者入院通道受阻是指需要住院的患者无法及时获得适当的住院床位，在澳大拉西亚地区，这一定义为在急诊超过 8 小时。本研究描述了在 4 年期间澳大利亚急诊通道受阻的患病率变化。
在六个星期一的上午 10 点（2004 年 5 月 31 日、8 月 30 日、2007 年 6 月 18 日、9 月 3 日、2008 年 6 月 2 日和 9 月 2 日）通过电子邮件、电话和传真对急诊进行调查。收集的数据包括索引时间点急诊患者的状态和最近急诊就诊人数的点数据。结果按州和医院角色进行整理和分析。
80 家符合条件的急诊中有 48 家（60%）回答了所有六次调查。4 年来，前一天到急诊就诊的人数增加了 15%（P<0.0001，配对 t 检验），全国范围内，急诊通道受阻的患者平均增加了 27%，等待看医生的患者增加了 31%。各州之间存在差异，新南威尔士州的医院报告称通道受阻患者显著减少（-51%，P=0.0002），但其他所有州的患者都显著增加（+45%，P=0.001）。医院角色也存在差异，非儿科主要转诊医院的通道受阻患者最多，但较小的医院等待就诊的患者增加最多。
在这些急诊调查中接受治疗的患者中，约有三分之一经历了通道受阻。有证据表明，新南威尔士州急诊的流程已经得到改善。数据表明，大多数医院已经过了效率的拐点。
