Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA.
Acad Emerg Med. 2010 Aug;17(8):840-7. doi: 10.1111/j.1553-2712.2010.00814.x.
Emergency department (ED) crowding has been identified as a major public health problem in the United States by the Institute of Medicine. ED crowding not only is associated with poorer patient outcomes, but it also contributes to lost demand for ED services when patients leave without being seen and hospitals must go on ambulance diversion. However, somewhat paradoxically, ED crowding may financially benefit hospitals. This is because ED crowding allows hospitals to maximize occupancy with well-insured, elective patients while patients wait in the ED. In this article, the authors propose a more holistic model of hospital flow and revenue that contradicts this notion and offer suggestions for improvements in ED and hospital management that may not only reduce crowding and improve quality, but also increase hospital revenues. Also proposed is that increased efficiency and quality in U.S. hospitals will require changes in systematic microeconomic and macroeconomic incentives that drive the delivery of health services in the United States. Finally, the authors address several questions to propose mutually beneficial solutions to ED crowding that include the realignment of hospital incentives, changing culture to promote flow, and several ED-based strategies to improve ED efficiency.
美国医学研究所已将急诊部门（ED）拥堵确定为一个重大的公共卫生问题。ED 拥堵不仅与患者预后较差有关，而且还会导致当患者在未得到治疗的情况下离开并导致医院必须转用救护车时，对 ED 服务的需求流失。然而，有点矛盾的是，ED 拥堵可能会使医院受益。这是因为 ED 拥堵允许医院在 ED 中等待的情况下，最大限度地利用有良好保险的非紧急患者来提高入住率。在本文中，作者提出了一个更全面的医院流量和收入模型，该模型与这一观点相矛盾，并为改善 ED 和医院管理提出了建议，这些建议不仅可以减少拥堵并提高质量，还可以增加医院收入。此外，作者还提出，美国医院的效率和质量的提高将需要改变推动美国医疗服务提供的系统微观经济和宏观经济激励措施。最后，作者提出了几个问题，以提出对 ED 拥堵有益的解决方案，包括重新调整医院激励措施、改变文化以促进流量，以及一些基于 ED 的策略来提高 ED 效率。
