Simpson Centre for Health Services Research Affiliated with The Australian Institute of Health Innovation, University of New South Wales, Kensington, New South Wales, Australia.
Emerg Med Australas. 2010 Apr;22(2):119-35. doi: 10.1111/j.1742-6723.2010.01270.x.
Prospective and retrospective access block hospital intervention studies from 1998 to 2008 were reviewed to assess the evidence for interventions around access block and ED overcrowding, including over 220 documents reported in Medline and data extracted from The State of our Public Hospitals Reports. There is an estimated 20-30% increased mortality rate due to access block and ED overcrowding. The main causes are major increases in hospital admissions and ED presentations, with almost no increase in the capacity of hospitals to meet this demand. The rate of available beds in Australia reduced from 2.6 beds per 1000 (1998-1999) to 2.4 beds per 1000 (2002-2007) in 2002, and has remained steady at between 2.5-2.6 beds per 1000. In the same period, the number of ED visits increased over 77% from 3.8 million to 6.74 million. Similarly, the number of public hospital admissions increased at an average rate of 3.4% per year from 3.7 to 4.7 million. Compared with 1998-1999 rates, the number of available beds in 2006-2007 is thus similar (2.65 vs 2.6 beds per 1000), but the number of ED presentations has almost doubled. All patient groups are affected by access block. Access block interventions may temporarily reduce some of the symptoms of access block, but many measures are not sustainable. The root cause of the problem will remain unless hospital capacity is addressed in an integrated approach at both national and state levels.
从 1998 年到 2008 年，对前瞻性和回顾性的准入障碍医院干预研究进行了审查，以评估围绕准入障碍和急诊科过度拥挤的干预措施的证据，包括在 Medline 上报告的 220 多份文件和从《我们的公立医院状况报告》中提取的数据。由于准入障碍和急诊科过度拥挤，死亡率估计增加了 20-30%。主要原因是医院入院和急诊科就诊人数大幅增加，而医院满足这一需求的能力几乎没有增加。澳大利亚的可用床位率从 1998-1999 年的每 1000 人 2.6 张床位降至 2002 年的每 1000 人 2.4 张床位，此后一直稳定在每 1000 人 2.5-2.6 张床位之间。同期，急诊科就诊人数增加了 77%以上，从 380 万增加到 674 万。同样，公立医院入院人数以每年 3.4%的平均速度增加，从 370 万增加到 470 万。与 1998-1999 年的比率相比，2006-2007 年的可用床位数量相似（每 1000 人 2.65 张与 2.6 张），但急诊科就诊人数几乎翻了一番。所有患者群体都受到准入障碍的影响。准入障碍干预措施可能暂时减轻一些准入障碍的症状，但许多措施不可持续。除非在国家和州两级以综合方式解决医院容量问题，否则问题的根源仍将存在。
