Wai Abraham K C, Chor C M, Lee Allen T C, Sittambunka Yuwares, Graham Colin A, Rainer Timothy H
Chinese University of Hong Kong, Hong Kong SAR.
Int J Emerg Med. 2009 Apr 8;2(3):141-8. doi: 10.1007/s12245-009-0098-7.
The workload of emergency departments (ED) continually changes in response to presentations, overcrowding and availability of expertise and investigations.
To investigate changes in ED presentations and care processes, and the relationship of patient demand and ED staff resources to waiting times and processing times.
Retrospective analysis of prospectively collected administrative data from January 1999 to April 2005 in an emergency department in a university teaching hospital in Hong Kong. All patients attending the emergency department during the study period were included. Monthly attendance data were retrieved and analysed to determine both qualitative and quantitative changes in the patterns of presentation to the ED using prospectively gathered data.
Total ED attendances decreased by 25% during the study with little seasonal variation. The admission rate and the use of ambulances increased steadily and significantly. Medical patients are increasing proportionately, but trauma patients are decreased in number.
There have been major changes in the patterns of ED attendances and ED waiting times over the study period in this teaching hospital ED. Decreasing overall ED numbers are offset by an increasingly elderly population and a more complex case mix. Reducing clinical staff numbers appears to reduce the ED's capacity to provide timely assessments and care and to function as hospital gatekeepers. Restoring staff numbers to previous levels may improve the quality and timeliness of ED services. It is necessary to refine measures of ED complexity and workload to determine appropriate staffing levels in the future.
急诊科的工作量会随着就诊情况、过度拥挤以及专业知识和检查的可获得性而不断变化。
调查急诊科就诊情况和护理流程的变化，以及患者需求和急诊科工作人员资源与等待时间和处理时间的关系。
对香港一所大学教学医院急诊科1999年1月至2005年4月前瞻性收集的管理数据进行回顾性分析。纳入研究期间所有到急诊科就诊的患者。检索并分析月度就诊数据，以利用前瞻性收集的数据确定急诊科就诊模式的定性和定量变化。
在研究期间，急诊科总就诊人数下降了25%，季节性变化不大。入院率和救护车使用率稳步且显著上升。内科患者比例在增加，但创伤患者数量在减少。
在这家教学医院急诊科的研究期间，急诊科就诊模式和等待时间发生了重大变化。总体急诊科就诊人数的减少被老年人口增加和病例组合更加复杂所抵消。临床工作人员数量的减少似乎降低了急诊科及时进行评估和护理以及充当医院守门人的能力。将工作人员数量恢复到以前的水平可能会提高急诊科服务的质量和及时性。有必要完善急诊科复杂性和工作量的衡量标准，以确定未来合适的人员配备水平。
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