LeBaron Johnathon, Culberson Marvin C, Wiley James F, Smith Sharon R
University of Connecticut, Storrs, CT, USA.
Pediatr Emerg Care. 2010 Nov;26(11):808-13. doi: 10.1097/PEC.0b013e3181fa8853.
The purpose of this study was to evaluate the combined effects of focused system changes on several key measures of emergency department (ED) quality (length of stay, waiting time, rate of leaving without being seen, and patient satisfaction) in a children's hospital ED.
System-wide ED changes were made and implemented during a 6-month period. The combined changes are called "be quick"--BEQK. The components were bedside registration, the Bed-ahead program, electronic medical records and tracking board, quick triage, and Kids Express. Three study periods were evaluated: before BEQK (2005) and the 2 periods after BEQK (2006 and 2007).
The primary outcome measures, namely wait time, length of stay, and leaving without being seen rates, were all decreased during the 2 post-BEQK periods compared with the pre-BEQK period (2005). The mean waiting time was 46 minutes (95% confidence interval [CI], 39-53 minutes) in 2005 and this decreased to 22 minutes (95% CI, 21-23 minutes) and 14 minutes (95% CI, 13-15 minutes) in 2006 and 2007, respectively. The mean length of stay was 151 minutes (95% CI, 139-163 minutes) in 2005 and this decreased to 136 minutes (95% CI, 135-137 minutes) and 115 minutes (95% CI, 114-116 minutes) in 2006 and 2007, respectively. The rate of leaving without being seen was 2.45% of patient visits per month in 2005 and this decreased to 1.67% in 2006 and to 0.92% in 2007.
In our pediatric ED, focused system changes significantly decreased wait time, leaving without being seen, and length of stay and improved patient satisfaction.
本研究旨在评估儿童医院急诊科针对系统进行的集中变革对急诊科质量的几个关键指标（住院时间、等待时间、未就诊离开率和患者满意度）产生的综合影响。
在6个月期间对整个急诊科系统进行了变革并实施。这些综合变革被称为“速行动”（BEQK）。其组成部分包括床边登记、床位预安排计划、电子病历与追踪板、快速分诊和儿童快速通道。评估了三个研究阶段：BEQK实施前（2005年）以及BEQK实施后的两个阶段（2006年和2007年）。
与BEQK实施前的阶段（2005年）相比，在BEQK实施后的两个阶段，主要结局指标，即等待时间、住院时间和未就诊离开率均有所下降。2005年平均等待时间为46分钟（95%置信区间[CI]，39 - 53分钟），2006年降至22分钟（95%CI，21 - 23分钟），2007年降至14分钟（95%CI，13 - 15分钟）。2005年平均住院时间为151分钟（95%CI，139 - 163分钟），2006年降至136分钟（95%CI，135 - 137分钟），2007年降至115分钟（95%CI，114 - 116分钟）。2005年每月未就诊离开率占患者就诊数的2.45%，2006年降至1.67%，2007年降至0.92%。
在我们的儿科急诊科，针对系统的集中变革显著缩短了等待时间、未就诊离开率和住院时间，并提高了患者满意度。
