Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA.
Ann Emerg Med. 2013 Jun;61(6):605-611.e6. doi: 10.1016/j.annemergmed.2012.10.026. Epub 2012 Dec 6.
Emergency department (ED) crowding is a prevalent health delivery problem and may adversely affect the outcomes of patients requiring admission. We assess the association of ED crowding with subsequent outcomes in a general population of hospitalized patients.
We performed a retrospective cohort analysis of patients admitted in 2007 through the EDs of nonfederal, acute care hospitals in California. The primary outcome was inpatient mortality. Secondary outcomes included hospital length of stay and costs. ED crowding was established by the proxy measure of ambulance diversion hours on the day of admission. To control for hospital-level confounders of ambulance diversion, we defined periods of high ED crowding as those days within the top quartile of diversion hours for a specific facility. Hierarchic regression models controlled for demographics, time variables, patient comorbidities, primary diagnosis, and hospital fixed effects. We used bootstrap sampling to estimate excess outcomes attributable to ED crowding.
We studied 995,379 ED visits resulting in admission to 187 hospitals. Patients who were admitted on days with high ED crowding experienced 5% greater odds of inpatient death (95% confidence interval [CI] 2% to 8%), 0.8% longer hospital length of stay (95% CI 0.5% to 1%), and 1% increased costs per admission (95% CI 0.7% to 2%). Excess outcomes attributable to periods of high ED crowding included 300 inpatient deaths (95% CI 200 to 500 inpatient deaths), 6,200 hospital days (95% CI 2,800 to 8,900 hospital days), and $17 million (95% CI $11 to $23 million) in costs.
Periods of high ED crowding were associated with increased inpatient mortality and modest increases in length of stay and costs for admitted patients.
急诊（ED）拥挤是一种普遍存在的医疗服务问题，可能会对需要住院的患者的治疗结果产生不利影响。我们评估了 ED 拥挤与住院患者后续结果之间的关系。
我们对 2007 年通过加利福尼亚州非联邦急性护理医院 ED 住院的患者进行了回顾性队列分析。主要结局是住院患者死亡率。次要结局包括住院时间和费用。ED 拥挤通过入院当天救护车分流时间的替代指标来确定。为了控制救护车分流的医院水平混杂因素，我们将 ED 拥挤的高峰期定义为特定医疗机构救护车分流时间最高的前四分之一天。层次回归模型控制了人口统计学、时间变量、患者合并症、主要诊断和医院固定效应。我们使用自举抽样来估计 ED 拥挤造成的超额结果。
我们研究了 995379 例导致 187 家医院住院的 ED 就诊。在 ED 拥挤高峰期入院的患者，住院死亡的可能性增加 5%（95%置信区间[CI] 2%至 8%），住院时间延长 0.8%（95%CI 0.5%至 1%），每例入院的费用增加 1%（95%CI 0.7%至 2%）。归因于 ED 拥挤高峰期的超额结果包括 300 例住院死亡（95%CI 200 至 500 例住院死亡），6200 个住院日（95%CI 2800 至 8900 个住院日）和 1700 万美元（95%CI 1100 万至 2300 万美元）的费用。
高峰期 ED 拥挤与住院患者的住院死亡率增加以及住院时间和费用的适度增加有关。
