Harvard Affiliated Emergency Medicine Residency, Boston, MA, USA.
Acad Emerg Med. 2013 Apr;20(4):374-80. doi: 10.1111/acem.12113.
The problem of emergency department (ED) crowding is well recognized; however, little data exist on the sustainability of potential solutions, including physician triage and screening. The authors hypothesized that a physician triage screening program (Supplemented Triage and Rapid Treatment [START]) sustainably improves standard ED performance metrics.
This retrospective, observational, before-and-after study compared performance measures over 4 years in a tertiary care urban academic medical center with approximately 90,000 annual ED visits. Patients seen between December 2006 and November 2010 were included. Outcome measures included length of stay (LOS) for ED patients, percentage of patients who left without completing assessment (LWCA), percentage of patients treated and dispositioned by START without using monitored beds, and door-to-room time. Descriptive statistics were used.
Median LOS for START patients was 56 minutes/patient lower when comparing 2010 to 2007 (p < 0.0001) and for non-START patients 22 minutes/patient lower (p < 0.0001). The percentage of patients who LWCA decreased from 4.8% to 2.9% (p < 0.0001) during the same time period. In START's first half-year, 18% of patients were discharged without using monitored beds. This increased to 29% by year 3. In addition, median door-to-room time decreased from 18.4 to 9.9 minutes during the same 3-year interval.
Physician screening appears to provide sustainable improvements in ED performance metrics including ED LOS, percentage of patients who LWCA, door-to-room time, and percentage of patients treated without using a monitored bed, despite increasing ED volume. Physician screening delivers additional incremental benefits for several years after implementation and can effectively increase ED capacity by allowing emergency physicians to more efficiently use monitored beds.
急诊部（ED）拥挤问题已得到充分认识；然而，关于潜在解决方案的可持续性的数据很少，包括医生分诊和筛查。作者假设，医生分诊筛查计划（补充分诊和快速治疗[START]）可持续改善标准 ED 绩效指标。
本回顾性、观察性、前后对照研究比较了一家三级城市学术医疗中心 4 年的绩效指标，该中心每年约有 90,000 名急诊患者。纳入 2006 年 12 月至 2010 年 11 月期间就诊的患者。观察指标包括 ED 患者的住院时间（LOS）、未完成评估（LWCA）的患者比例、不使用监测床位通过 START 治疗和处置的患者比例，以及从门口到房间的时间。采用描述性统计。
比较 2010 年和 2007 年，START 患者的 LOS 中位数降低了 56 分钟/患者（p < 0.0001），非 START 患者的 LOS 中位数降低了 22 分钟/患者（p < 0.0001）。在同一时期，LWCA 的患者比例从 4.8%下降到 2.9%（p < 0.0001）。在 START 的前半年，有 18%的患者无需使用监测床位即可出院，到第 3 年增加到 29%。此外，在同一 3 年期间，中位数从 18.4 分钟减少到 9.9 分钟。
尽管 ED 量增加，但医生筛查似乎可持续改善 ED 绩效指标，包括 ED LOS、LWCA 患者比例、从门口到房间的时间，以及无需使用监测床位治疗的患者比例。医生筛查在实施后几年内提供额外的增量收益，并可通过允许急诊医生更有效地使用监测床位来有效增加 ED 容量。
