Kulstad Erik B, Kelley Ken M
Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, IL 60453, USA.
Int J Emerg Med. 2009 Jun 5;2(3):149-54. doi: 10.1007/s12245-009-0107-x.
Recently developed crowding measures, such as the Emergency Department (ED) Work Index (EDWIN) score, provide a quantifiable measurement of overcrowding in the ED.
We sought to determine the association between overcrowding, measured with the EDWIN score, and the time required to initiate percutaneous coronary intervention (PCI) for patients presenting to the ED with acute myocardial infarction (AMI).
We retrospectively reviewed the performance improvement (PI) data on all patients presenting to the ED over a 2-month period with chest pain and whose subsequent ECG showed AMI requiring PCI. We recorded the time from patient presentation to the (1) time to first ECG, (2) time to patient arrival in the catheterization laboratory, and (3) time to catheter balloon inflation. We calculated EDWIN scores using data archived from our electronic tracking board and compared the proportion of patients who achieved our established ED goal times between patients presenting during low crowding (EDWIN < 1.5) and high crowding (EDWIN > or = 1.5) conditions.
Seventeen patients underwent emergent PCI in the study period. Patients presenting to the ED during periods of low crowding had shorter times to balloon inflation (median of 84 min, IQR 80 to 93 min) than patients presenting to the ED during periods of high crowding (median of 107 min, IQR 94 to 122 min), P = 0.008. Times to first ECG and to arrival in the catheterization laboratory were not significantly different between patients presenting during low and high crowding conditions.
Overcrowding appears to be associated with a decreased likelihood of timely treatment for acute AMI in our ED.
最近开发的拥挤度测量方法，如急诊科（ED）工作指数（EDWIN）评分，可对急诊科的过度拥挤情况进行量化测量。
我们试图确定用EDWIN评分衡量的过度拥挤与急性心肌梗死（AMI）患者到急诊科就诊后启动经皮冠状动脉介入治疗（PCI）所需时间之间的关联。
我们回顾性分析了在2个月内所有因胸痛到急诊科就诊且后续心电图显示AMI需要PCI的患者的绩效改进（PI）数据。我们记录了从患者就诊到（1）首次心电图检查时间、（2）患者到达导管室的时间以及（3）导管球囊扩张时间。我们使用从电子追踪板存档的数据计算EDWIN评分，并比较了在低拥挤（EDWIN < 1.5）和高拥挤（EDWIN >或= 1.5）情况下就诊的患者中达到我们既定的急诊科目标时间的患者比例。
在研究期间，17例患者接受了急诊PCI。与在高拥挤时期到急诊科就诊的患者相比，在低拥挤时期到急诊科就诊的患者球囊扩张时间更短（中位数为84分钟，四分位数间距为80至93分钟），而高拥挤时期就诊患者的球囊扩张时间中位数为107分钟，四分位数间距为94至122分钟，P = 0.008。在低拥挤和高拥挤情况下就诊的患者首次心电图检查时间和到达导管室的时间没有显著差异。
在我们的急诊科，过度拥挤似乎与急性AMI及时治疗的可能性降低有关。
