Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Ann Emerg Med. 2012 Dec;60(6):679-686.e3. doi: 10.1016/j.annemergmed.2012.05.014. Epub 2012 Jun 20.
We evaluate recent trends in emergency department (ED) crowding and its potential causes by analyzing ED occupancy, a proxy measure for ED crowding.
We analyzed data from the annual National Hospital Ambulatory Medical Care Surveys from 2001 to 2008. The surveys abstract patient records from a national sample of hospital EDs to generate nationally representative estimates of visits. We used time of ED arrival and length of ED visit to calculate mean and hourly ED occupancy.
During the 8-year study period, the number of ED visits increased by 1.9% per year (95% confidence interval 1.2% to 2.5%), a rate 60% faster than population growth. Mean occupancy increased even more rapidly, at 3.1% per year (95% confidence interval 2.3% to 3.8%), or 27% during the 8 study years. Among potential factors associated with crowding, the use of advanced imaging increased most, by 140%. But advanced imaging had a smaller effect on the occupancy trend than other more common throughput factors, such as the use of intravenous fluids and blood tests, the performance of any clinical procedure, and the mention of 2 or more medications. Of patient characteristics, Medicare payer status and the age group 45 to 64 years accounted for small disproportionate increases in occupancy.
Despite repeated calls for action, ED crowding is getting worse. Sociodemographic changes account for some of the increase, but practice intensity is the principal factor driving increasing occupancy levels. Although hospital admission generated longer ED stays than any other factor, it did not influence the steep trend in occupancy.
通过分析急诊部（ED）占用率这一代表 ED 拥挤程度的代理指标，评估 ED 拥挤的近期趋势及其潜在原因。
我们分析了 2001 年至 2008 年期间每年进行的国家医院门诊医疗调查的数据。这些调查从全国范围内的医院 ED 中抽取患者记录，生成具有全国代表性的就诊量估计值。我们使用 ED 到达时间和 ED 就诊时间来计算平均和每小时 ED 占用率。
在 8 年的研究期间，ED 就诊量每年增加 1.9%（95%置信区间 1.2%至 2.5%），增长率比人口增长率快 60%。平均占用率的增长速度甚至更快，每年增长 3.1%（95%置信区间 2.3%至 3.8%），或在 8 年的研究期间增加了 27%。在与拥挤相关的潜在因素中，高级影像学的使用增长最多，增长了 140%。但与其他更常见的吞吐量因素相比，高级影像学对占用率趋势的影响较小，如静脉输液和血液检查的使用、任何临床程序的执行以及提到 2 种或更多种药物。在患者特征中，医疗保险支付者状态和 45 至 64 岁年龄组导致占用率不成比例地略有增加。
尽管一再呼吁采取行动，但 ED 拥挤状况仍在恶化。社会人口变化是增加的部分原因，但实践强度是导致占用率不断上升的主要因素。尽管住院治疗导致 ED 停留时间比任何其他因素都长，但它并没有影响占用率的陡峭趋势。
