Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, IL 60453, USA.
Am J Emerg Med. 2010 Sep;28(7):809-12. doi: 10.1016/j.ajem.2009.06.023. Epub 2010 Jan 28.
We measured the correlation between emergency department (ED) occupancy rate and time to antibiotic administration for patients with pneumonia treated in a community hospital setting.
We reviewed quality improvement data on patients treated for pneumonia in our ED and admitted over a 5-month period. The outcomes were timeliness of antibiotic therapy (within 4 hours of arrival) and overall time to antibiotic administration. Emergency department crowding was measured as the ED occupancy rate. We calculated (1) the Spearman correlation between occupancy rate at time of patient presentation and the time to antibiotic administration, (2) the odds ratio of receiving antibiotics within 4 hours with increasing ED occupancy, and (3) the ability of the occupancy rate to predict failure of achieving the 4-hour goal with the receiver operating characteristic curve.
A total of 334 patients were treated over the study period, of which 262 had complete data available. Occupancy rate ranged from 20% to 245%, and median was 137%. Eighty-one percent received antibiotics within 4 hours; the median time was 150 minutes. Time to antibiotics showed a positive correlation with occupancy rate (Spearman ρ = 0.17, P = .008). An increasing ED occupancy rate was associated with decreased odds of receiving antibiotics within 4 hours (odds ratio, 0.31; 95% confidence interval, 0.13-0.75). Receiver operating characteristic curve area was 0.62 (95% confidence interval, 0.54-0.70; P = .009).
Emergency department occupancy rate was associated with increased time to antibiotic treatment for patients admitted with pneumonia. Occupancy rate had fair success in predicting failure of treatment within 4 hours.
我们测量了社区医院治疗的肺炎患者的急诊部（ED）入住率与抗生素给药时间之间的相关性。
我们回顾了在我们的 ED 治疗并在 5 个月期间入院的肺炎患者的质量改进数据。结果是抗生素治疗的及时性（到达后 4 小时内）和抗生素给药的总时间。ED 拥挤程度用 ED 入住率来衡量。我们计算了（1）患者就诊时入住率与抗生素给药时间之间的 Spearman 相关系数，（2）ED 入住率增加时 4 小时内接受抗生素的几率比，以及（3）入住率预测 4 小时目标失败的能力，使用受试者工作特征曲线。
在研究期间共治疗了 334 例患者，其中 262 例有完整的数据。入住率范围从 20%到 245%，中位数为 137%。81%的患者在 4 小时内接受了抗生素治疗；中位数时间为 150 分钟。抗生素给药时间与入住率呈正相关（Spearman ρ = 0.17，P =.008）。ED 入住率增加与 4 小时内接受抗生素治疗的几率降低相关（比值比，0.31；95%置信区间，0.13-0.75）。受试者工作特征曲线面积为 0.62（95%置信区间，0.54-0.70；P =.009）。
急诊部入住率与肺炎患者接受抗生素治疗的时间增加有关。入住率在预测 4 小时内治疗失败方面有一定的成功。
