Department of Surgery/Division of Emergency Medicine, Stanford University School of Medicine, 701 Welch Road, Palo Alto, CA 94304, USA.
Ann Emerg Med. 2010 Mar;55(3):268-73. doi: 10.1016/j.annemergmed.2009.11.025. Epub 2010 Jan 15.
During a pandemic, emergency departments (EDs) may be overwhelmed by an increase in patient visits and will foster an environment in which cross-infection can occur. We developed and tested a novel drive-through model to rapidly evaluate patients while they remain in or adjacent to their vehicles. The patient's automobile would provide a social distancing strategy to mitigate the person-to-person spread of infectious diseases.
We conducted a full-scale exercise to test the feasibility of a drive-through influenza clinic and measure throughput times of simulated patients and carbon monoxide levels of staff. We also assessed the disposition decisions of the physicians who participated in the exercise. Charts of 38 patients with influenza-like illness who were treated in the Stanford Hospital ED during the initial H1N1 outbreak in April 2009 were used to create 38 patient scenarios for the drive-through influenza clinic.
The total median length of stay was 26 minutes. During the exercise, physicians were able to identify those patients who were admitted and discharged during the real ED visit with 100% accuracy (95% confidence interval 91% to 100%). There were no significant increases of carboxyhemoglobin in participants tested.
The drive-through model is a feasible alternative to a traditional walk-in ED or clinic and is associated with rapid throughput times. It provides a social distancing strategy, using the patient's vehicle as an isolation compartment to mitigate person-to-person spread of infectious diseases.
在大流行期间，急诊科（ED）可能会因就诊患者增加而不堪重负，并会形成一个容易发生交叉感染的环境。我们开发并测试了一种新型的免下车模型，以便在患者仍在或紧邻其车辆时对其进行快速评估。患者的汽车将提供社交隔离策略，以减轻传染病的人际传播。
我们进行了全面的演习，以测试免下车流感诊所的可行性，并测量模拟患者的吞吐量时间和工作人员的一氧化碳水平。我们还评估了参与演习的医生的处置决策。使用在 2009 年 4 月甲型 H1N1 爆发期间在斯坦福医院 ED 治疗的 38 例流感样疾病患者的图表为免下车流感诊所创建了 38 个患者场景。
总中位数停留时间为 26 分钟。在演习过程中，医生能够以 100%的准确率（95%置信区间 91%至 100%）识别出在实际 ED 就诊期间入院和出院的患者。接受测试的参与者中没有明显的碳氧血红蛋白升高。
免下车模型是传统的步行式 ED 或诊所的可行替代方案，并且与快速吞吐量时间相关。它提供了一种社交隔离策略，使用患者的车辆作为隔离舱，以减轻传染病的人际传播。
