Department of Pediatrics and Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Ann Emerg Med. 2011 Jan;57(1):52-9. doi: 10.1016/j.annemergmed.2010.08.026. Epub 2010 Oct 13.
We compare emergency department (ED) patient flow during the fall 2009 novel H1N1-associated surge in patient volumes at an urban, tertiary care, pediatric medical center to that in the previous winter virus season.
A rapid medical screening process was instituted to manage the surge in patient census. The process included the use of a new, separate clinical area converted from office space adjacent to the ED, the introduction of a new preprinted checklist for rapid documentation of medical history and physical examination of patients with influenza-like illness, the use of classroom-style parent discharge education, and the use of preprinted discharge prescription and instructions. We compared patient flow parameters, including waiting time, length of stay, and elopement rates, and returns within 48 hours and 7 days for a comparable period in winter 2008 to 2009.
During the first 30 days of the novel H1N1-associated surge in patient volumes (October 12 to November 10, 2009), overall ED daily volumes increased by a mean of 113 (51.8%) compared with baseline (daily increase range 49 to 118 patients). Of the 10,013 patients treated during this period, 4,287 (42.8%) had complaints consistent with influenza-like illness and 1,767 (17.6%) were treated with the rapid screening process. The mean wait time decreased from 92.9 to 81.2 minutes (difference 11.7 minutes; 95% confidence interval [CI] 10.2 to 13.2 minutes). Overall mean ED length of stay decreased from 241 to 212.3 minutes (difference 28.7 minutes; 95% CI 25.8 to 31.6 minutes). Rates of elopement were unchanged, and elopement rates as a function of daily patient volumes showed improved responsiveness to high volumes. Rates of return were unchanged within 48 hours (3.0% in 2009 versus 2.9% in 2008; odds ratio 1.03 [0.91 to 1.18]) and within 7 days (6.2% in 2009 versus 5.7% in 2008; odds ratio 1.09 [0.99 to 1.20]). The use of the rapid screening process required a mean of 23.5 (95% CI 16.4 to 30.6) additional hours per day of physician staffing and a mean of 26.3 (95% CI 18.5 to 34.1) additional hours of nursing staffing.
The implementation of a rapid screening process during the fall 2009 H1N1-associated surge in patient volumes was associated with improved patient flow without affecting rates of return to the ED within 48 hours or 7 days. This was accomplished with only a modest increase in staffing.
我们比较了秋季 2009 年新型 H1N1 相关患者数量激增期间，城市三级护理儿科医疗中心急诊科患者流量与前一年冬季病毒季节的患者流量。
快速医疗筛选流程被用于管理患者人数的激增。该流程包括利用毗邻急诊室的办公空间新建一个单独的临床区域，引入一个新的、预印的检查表，以便快速记录流感样疾病患者的病史和体格检查，采用课堂式家长出院教育，以及使用预印的出院处方和说明。我们比较了等待时间、停留时间和逃跑率等患者流量参数，并将 2008 年至 2009 年冬季同期的 48 小时和 7 天内的返回率进行了比较。
在新型 H1N1 相关患者数量激增的头 30 天（2009 年 10 月 12 日至 11 月 10 日），与基线相比，急诊部每日总流量增加了 113 人（增加幅度为 51.8%）（每日增加幅度为 49 至 118 人）。在这期间接受治疗的 10013 名患者中，有 4287 名（42.8%）有流感样症状，1767 名（17.6%）接受了快速筛查流程。平均等待时间从 92.9 分钟减少到 81.2 分钟（差异为 11.7 分钟；95%置信区间 [CI] 10.2 至 13.2 分钟）。总体急诊停留时间从 241 分钟减少到 212.3 分钟（差异为 28.7 分钟；95%置信区间为 25.8 至 31.6 分钟）。逃跑率保持不变，并且逃跑率与每日患者数量的函数关系显示出对高流量的响应能力有所提高。48 小时内的返回率没有变化（2009 年为 3.0%，2008 年为 2.9%；比值比为 1.03 [0.91 至 1.18]），7 天内的返回率也没有变化（2009 年为 6.2%，2008 年为 5.7%；比值比为 1.09 [0.99 至 1.20]）。快速筛查流程的实施需要每天增加平均 23.5 名（95%置信区间为 16.4 至 30.6）医生人手和平均 26.3 名（95%置信区间为 18.5 至 34.1）护士人手。
在秋季 2009 年新型 H1N1 相关患者数量激增期间，实施快速筛查流程可改善患者流量，而不会影响 48 小时或 7 天内返回急诊室的比例。这仅通过适度增加人员配置就实现了。
