共同定位的全科医生（GP）诊所和患者选择对急诊科等待时间的影响。

Impact of co-located general practitioner (GP) clinics and patient choice on duration of wait in the emergency department.

机构信息

Centre for Health Economics, Monash University, Melbourne VIC 3800, Australia.

出版信息

Emerg Med J. 2011 Aug;28(8):658-61. doi: 10.1136/emj.2009.086512. Epub 2010 Jul 28.

DOI:10.1136/emj.2009.086512

PMID:20668112

Abstract

OBJECTIVE

To empirically model the determinants of duration of wait of emergency (triage category 2) patients in an emergency department (ED) focusing on two questions: (i) What is the effect of enhancing the degree of choice for non-urgent (triage category 5) patients on duration of wait for emergency (category 2) patients in EDs; and (ii) What is the effect of co-located GP clinics on duration of wait for emergency patients in EDs? The answers to these questions will help in understanding the effectiveness of demand management strategies, which are identified as one of the solutions to ED crowding.

METHODS

The duration of wait for each patient (difference between arrival time and time first seen by treating doctor) was modelled as a function of input factors (degree of choice, patient characteristics, weekend admission, metro/regional hospital, concentration of emergency (category 2) patients in hospital service area), throughput factors (availability of doctors and nurses) and output factor (hospital bed capacity). The unit of analysis was a patient episode and the model was estimated using a survival regression technique.

RESULTS

The degree of choice for non-urgent (category 5) patients has a non-linear effect: more choice for non-urgent patients is associated with longer waits for emergency patients at lower values and shorter waits at higher values of degree of choice. Thus more choice of EDs for non-urgent patients is related to a longer wait for emergency (category 2) patients in EDs. The waiting time for emergency patients in hospital campuses with co-located GP clinics was 19% lower (1.5 min less) on average than for those waiting in campuses without co-located GP clinics.

CONCLUSION

These findings suggest that diverting non-urgent (category 5) patients to an alternative model of care (co-located GP clinics) is a more effective demand management strategy and will reduce ED crowding.

摘要

目的

针对急诊科（ED）中 2 级紧急（分类 2）患者的等待时间，通过实证模型来确定其决定因素，重点关注以下两个问题：（i）增强非紧急（分类 5）患者的选择程度对 ED 中分类 2 紧急患者等待时间的影响；（ii）毗邻全科医生（GP）诊所对 ED 中紧急患者等待时间的影响。这些问题的答案将有助于了解需求管理策略的有效性，这些策略被确定为解决 ED 拥堵问题的方法之一。

方法

将每位患者的等待时间（到达时间与首次由主治医生接诊的时间之差）建模为输入因素（选择程度、患者特征、周末入院、城区/地区医院、医院服务区域内紧急（分类 2）患者的集中程度）、吞吐量因素（医生和护士的可用性）和输出因素（医院床位容量）的函数。分析单元为一个患者病例，使用生存回归技术对模型进行估计。

结果

非紧急（分类 5）患者的选择程度呈非线性影响：非紧急患者的选择程度越高，在较低值时与急诊患者的等待时间越长，而在较高值时等待时间越短。因此，非紧急患者对 ED 的选择程度越高，ED 中紧急（分类 2）患者的等待时间就越长。与没有毗邻 GP 诊所的校园相比，有毗邻 GP 诊所的医院校园中急诊患者的等待时间平均减少了 19%（1.5 分钟）。