Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY, USA.
Acad Emerg Med. 2010 May;17(5):501-7. doi: 10.1111/j.1553-2712.2010.00738.x.
Increases in emergency department (ED) visits may place a substantial burden on both the ED and hospital-based laboratories. Studies have identified laboratory turnaround time (TAT) as a barrier to patient process times and lengths of stay. Prolonged laboratory study results may also result in delayed recognition of critically ill patients and initiation of appropriate therapies. The objective of this study was to determine how ED patient volume itself is associated with laboratory TAT.
This was a retrospective cohort review of patients at five academic, tertiary care EDs in the United States. Data were collected on all adult patients seen in each ED with troponin laboratory testing during the months of January, April, July, and October 2007. Primary predictor variables were two ED patient volume measures at the time the troponin test was ordered: 1) number of all patients in the ED/number of beds (occupancy) and 2) number of admitted patients waiting for beds/beds (boarder occupancy). The outcome variable was troponin turnaround time (TTAT). Adjusted covariates included patient characteristics, triage severity, season (month of the laboratory test), and site. Multivariable adjusted quantile regression was carried out to assess the association of ED volume measures with TTAT.
At total of 9,492 troponin tests were reviewed. Median TTAT for this cohort was 107 minutes (interquartile range [IQR] = 73-148 minutes). Median occupancy for this cohort was 1.05 patients (IQR = 0.78-1.38 patients) and median boarder occupancy was 0.21 (IQR = 0.11-0.32). Adjusted quantile regression demonstrated a significant association between increased ED patient volume and longer times to TTAT. For every 100% increase in census, or number of boarders over the number of ED beds, respectively, there was a 12 (95% confidence interval [CI] = 9 to 14) or 33 (95% CI = 24 to 42)-minute increase in TTAT.
Increased ED patient volume is associated with longer hospital laboratory processing times. Prolonged laboratory TAT may delay recognition of conditions in the acutely ill, potentially affecting clinician decision-making and the initiation of timely treatment. Use of laboratory TAT as a patient throughput measure and the study of factors associated with its prolonging should be further investigated.
急诊部（ED）就诊人数的增加可能给 ED 和医院检验科都带来巨大的负担。研究已经确定，实验室周转时间（TAT）是影响患者流程时间和住院时间的一个障碍。实验室检测结果的延迟可能导致对重症患者的识别延迟，并延误合适的治疗。本研究的目的是确定 ED 患者数量本身与实验室 TAT 之间的关系。
这是在美国五所学术性三级保健 ED 进行的回顾性队列研究。2007 年 1 月、4 月、7 月和 10 月，收集了所有在 ED 进行肌钙蛋白检测的成年患者的数据。主要预测变量是在肌钙蛋白检测开单时的两个 ED 患者数量指标：1）ED 内所有患者的数量/床位数（入住率）和 2）等待床位的入院患者数量/床位数（加床入住率）。结局变量是肌钙蛋白 TAT（TTAT）。调整后的协变量包括患者特征、分诊严重程度、季节（实验室检测月份）和地点。采用多变量调整分位数回归评估 ED 量度与 TTAT 的关联。
共回顾了 9492 次肌钙蛋白检测。该队列的中位数 TTAT 为 107 分钟（四分位距 [IQR] = 73-148 分钟）。该队列的中位数入住率为 1.05 名患者（IQR = 0.78-1.38 名患者），中位数加床入住率为 0.21（IQR = 0.11-0.32）。调整后的分位数回归显示，ED 患者数量的增加与 TTAT 时间的延长之间存在显著的相关性。每增加 100%的患者人数或每增加 100%的加床人数与 ED 床位相比，TTAT 分别增加 12 分钟（95%置信区间 [CI] = 9 至 14）或 33 分钟（95% CI = 24 至 42）。
ED 患者数量的增加与医院实验室处理时间的延长有关。实验室 TAT 延长可能会延迟对急性疾病的识别，从而影响临床医生的决策和及时治疗的开始。应进一步研究将实验室 TAT 用作患者吞吐量指标和与延长相关的因素。
