Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Am J Med. 2012 Apr;125(4):416.e1-7. doi: 10.1016/j.amjmed.2011.07.030. Epub 2012 Feb 3.
Boarding admitted patients in the emergency department due to high hospital occupancy is a worldwide problem. However, whether or not emergency department-boarded patients managed by emergency department providers subjects them to increased serious complications needs further clarification.
A multivariate logistic regression analysis was used to examine the relationship of patient's age, sex, arrival hours, diagnostic category, triage category, daily emergency department visits, and daily hospital occupancy to the occurrence of serious complications within 24 hours for 20,276 emergency admissions in a 4-year period.
A vast majority of study days (86.5%) saw very high occupancy ≥90%. Serious complications incidence was 13.62 per 1000 patient days when hospital occupancy was ≤90%, and it increased significantly to 17.10 and 22.52 per 1000 patient days for occupancy at 90%-95% and ≥95%, respectively. In the multivariate analysis, significant risk factors for serious complications included daily occupancy ≥95% (adjusted odds ratio [OR] 1.73; 95% confidence interval [CI], 1.26-2.39), triage category (adjusted OR 0.20; 95% CI, 0.17-0.24), and specific diagnoses (injury and poisoning [adjusted OR 1.62; 95% CI, 1.22-2.84], respiratory [adjusted OR 2.48; 95% CI, 1.37-4.49], and circulatory [adjusted OR 3.24; 95% CI, 1.80-5.80]).
High hospital occupancy was associated with an increased incidence of serious complications within 24 hours for patients admitted but still boarded in the emergency department and managed by emergency department providers.
由于医院入住率高，将患者收入急诊科是一个全球性的问题。然而，由急诊科医生管理的急诊科收治患者是否会导致更严重的并发症，还需要进一步澄清。
采用多变量逻辑回归分析，考察了 4 年期间 20276 例急诊入院患者的年龄、性别、入院时间、诊断类别、分诊类别、每日急诊就诊次数和每日医院入住率与 24 小时内发生严重并发症的关系。
绝大多数研究日（86.5%）的入住率非常高（≥90%）。当医院入住率≤90%时，严重并发症的发生率为每 1000 个患者日 13.62 例；当入住率为 90%-95%和≥95%时，严重并发症的发生率显著增加至每 1000 个患者日 17.10 和 22.52 例。多变量分析表明，严重并发症的显著危险因素包括每日入住率≥95%（调整后的优势比[OR]1.73；95%置信区间[CI]，1.26-2.39）、分诊类别（调整后的 OR 0.20；95% CI，0.17-0.24）和特定诊断（损伤和中毒[调整后的 OR 1.62；95% CI，1.22-2.84]、呼吸系统[调整后的 OR 2.48；95% CI，1.37-4.49]和循环系统[调整后的 OR 3.24；95% CI，1.80-5.80]）。
对于仍在急诊科接受治疗且由急诊科医生管理的入院患者，高医院入住率与 24 小时内发生严重并发症的发生率增加相关。
