Handel Daniel A, Ginde Adit A, Raja Ali S, Rogers John, Sullivan Ashley F, Espinola Janice A, Camargo Carlos A
Int J Emerg Med. 2010 Aug 21;3(4):279-86. doi: 10.1007/s12245-010-0216-6.
We sought to measure the self-reported implementation of the crowding solutions outlined in the 2008 American College of Emergency Physicians (ACEP) Boarding Task Force report "Emergency Department Crowding: High-Impact Solutions." We also tested the hypothesis that the self-reported crowding of emergency departments (EDs) was positively associated with the implementation of these solutions.
In early 2009, we mailed a survey to all medical or nursing directors from EDs in four US states asking for information regarding their EDs in 2008. Geographic information about the EDs was included in the analysis, along with survey responses about their ED capacity status and implementation of specific ACEP crowding solutions.
A total of 284 of 351 EDs responded (81%). The majority of EDs were in urban areas (56%), non-teaching hospitals (93%), and not critical access hospitals (76%). The percentage of EDs "over capacity" ranged from 10-49% in each state. The mean number of crowding solutions used in EDs that were at or over capacity ranged from 3.6-4.6 in each state. EDs with visit volumes greater than or equal to three patients/hour were more likely to be over capacity than at capacity or at a good balance (46% vs. 31% and 15%, respectively). In terms of the use of high-impact crowding solutions, hospitals over capacity were more likely to utilize inpatient full capacity protocols (40% vs. 25% and 25%) but not inpatient discharge coordination (29% vs. 27% and 34%) or surgical schedule smoothing (31% vs. 28% and 32%). Hospitals over capacity were also more likely to have fast track units (44% vs. 32% and 16%) and physicians at triage (48% vs. 29% and 17%).
Less than half of EDs in each state reported operation above capacity. Implementation of some crowding solutions was more common in the above-capacity EDs, although these solutions were not consistently used across geographic locations and hospitals. Given that the majority of EDs were not over capacity, the implementation of these solutions does not seem to be universally necessary.
我们试图衡量2008年美国急诊医师学会（ACEP）住院问题特别工作组报告《急诊科拥挤：高影响力解决方案》中概述的拥挤解决方案的自我报告实施情况。我们还检验了以下假设：急诊科（ED）自我报告的拥挤情况与这些解决方案的实施呈正相关。
2009年初，我们向美国四个州的所有急诊科医疗或护理主任邮寄了一份调查问卷，询问他们2008年急诊科的相关信息。分析中纳入了急诊科的地理信息，以及关于其急诊科容量状态和ACEP特定拥挤解决方案实施情况的调查回复。
351家急诊科中有284家回复（81%）。大多数急诊科位于城市地区（56%）、非教学医院（93%），且不是急救医院（76%）。每个州“超容量”的急诊科比例在10%至49%之间。每个州容量达到或超过容量的急诊科使用的拥挤解决方案平均数量在3.6至4.6之间。就诊量大于或等于每小时3名患者的急诊科超容量的可能性高于容量正常或平衡良好的急诊科（分别为46%、31%和15%）。在使用高影响力拥挤解决方案方面，超容量的医院更有可能采用住院部满负荷方案（40%、25%和25%），但在住院患者出院协调（29%、27%和34%）或手术日程安排优化方面并非如此（31%、28%和32%）。超容量的医院也更有可能设有快速通道单元（44%、32%和16%）和分诊医师（48%、29%和17%）。
每个州不到一半的急诊科报告运营超出容量。一些拥挤解决方案在超容量的急诊科中实施更为普遍，尽管这些解决方案在不同地理位置和医院的使用并不一致。鉴于大多数急诊科未超容量，这些解决方案似乎并非普遍必要。
