Klinikum Fürth, Zentrale Notaufnahme, Lehrkrankenhaus der Universität Erlangen Nürnberg.
Dtsch Arztebl Int. 2010 Apr;107(15):261-7. doi: 10.3238/arztebl.2010.0261. Epub 2010 Apr 16.
Despite calls for improved quality and efficiency in medical emergency departments, there exist hardly any quality indicators, and no methods of calculating efficiency have been published to date. The present study illustrates a means of presenting numerical parameters of a medical emergency department and of identifying potential quality indicators.
Over a period of 12 months, all patient contacts of the medical emergency department in the University hospital of Erlangen were analyzed with respect to patient flow, diagnoses, and treatment units. The diagnostic agreement (DA) parameter was calculated from a systematic comparison of admitting and discharge diagnoses, and diagnostic efficiency (DE) was defined and calculated as the quotient of DA x100 divided by the length of stay in the emergency department.
Among the 6683 patients treated, 64.6% underwent further in-hospital care. The diagnostic spectrum of the outpatients differed markedly from that of the inpatients. Patients with diseases of the heart, gastrointestinal tract, and lungs were usually admitted to the hospital for further treatment. Patient contacts had a characteristic circadian and weekly rhythmic pattern. For the overall patient collective, the DA was 71%. The mean length of stay in the emergency department was 116 minutes, and the DE was therefore 0.61/min. The DA was highest (92%) among patients with atrial flutter or fibrillation, while the DE was highest (0.85/min) among patients with acute myocardial infarction. 14% of the patients required further treatment in intensive care.
Numerical parameters and quality indicators for a hospital emergency department can be presented in transparent fashion. DA and DE can be used as parameters for diagnosis-related and intradepartmental quality assessment.
尽管呼吁提高医疗急救部门的质量和效率，但几乎没有任何质量指标，也没有公布任何计算效率的方法。本研究展示了一种呈现医疗急救部门数值参数和确定潜在质量指标的方法。
在 12 个月的时间里，对埃尔兰根大学医院急救部门的所有患者接触情况进行了分析，涉及患者流程、诊断和治疗单位。从系统比较入院和出院诊断中计算出诊断一致性（DA）参数，并将诊断效率（DE）定义为 DA x100 除以在急诊部门的停留时间的商。
在接受治疗的 6683 名患者中，有 64.6%的患者需要进一步住院治疗。门诊患者的诊断范围与住院患者明显不同。患有心脏病、胃肠道和肺部疾病的患者通常会住院接受进一步治疗。患者接触具有明显的昼夜和每周节律模式。对于整个患者群体，DA 为 71%。急诊部门的平均停留时间为 116 分钟，因此 DE 为 0.61/min。心房颤动或心房扑动患者的 DA 最高（92%），而急性心肌梗死患者的 DE 最高（0.85/min）。14%的患者需要在重症监护室接受进一步治疗。
可以以透明的方式呈现医院急救部门的数值参数和质量指标。DA 和 DE 可用作与诊断相关和部门内质量评估的参数。
