Komindr Atthasit, Baugh Christopher W, Grossman Shamai A, Bohan J Stephen
Emergency Unit, King Chulalongkorn Memorial Hospital, 1873 Rama 4 Road, Pathumwan, Bangkok 10330, Thailand.
Int J Emerg Med. 2014 Feb 5;7(1):6. doi: 10.1186/1865-1380-7-6.
To improve efficiency, emergency departments (EDs) use dedicated observation units (OUs) to manage patients who are unable to be discharged home, yet do not clearly require inpatient hospitalization. However, operational metrics and their ideal targets have not been created for this setting and patient population. Variation in these metrics across different countries has not previously been reported. This study aims to define and compare key operational characteristics between three ED OUs in the United States (US) and three ED OUs in Asia.
This is a descriptive study of six tertiary-care hospitals, all of which are level 1 trauma centers and have OUs managed by ED staff. We collected data via various methods, including a standardized survey, direct observation, and interviews with unit leadership, and compared these data across continents.
We define multiple key operational characteristics to compare between sites, including OU length of stay (LOS), OU discharge rate, and bed turnover rate. OU LOS in the US and Asian sites averaged 12.9 hours (95% CI, 8.3 to 17.5) and 20.5 hours (95% CI, -49.4 to 90.4), respectively (P = 0.39). OU discharge rates in the US and Asia averaged 84.3% (95% CI, 81.5 to 87.2) and 88.7% (95% CI, 81.5 to 95.8), respectively (P = 0.11), and the bed turnover rates in the US and Asian sites averaged 1.6 patients/bed/day (95% CI, -0.1 to 3.3) and 0.9 patient/bed/day (95% CI, -0.6 to 2.4), respectively (P = 0.27).
Prior research has shown that the OU is a resource that can mitigate many of problems in the ED and hospital, while simultaneously improving patient care and satisfaction. We describe key operational characteristics that are relevant to all OUs, regardless of geography or healthcare system to monitor and maximize efficiency. Although measures of LOS and bed turnover varied widely between US and Asian sites, we did not find a statistically significant difference. Use of these metrics may enable hospitals to establish or revise an ED OU and reduce OU LOS, increase bed turnover, and discharge rates while simultaneously improving patient satisfaction and quality of care.
为提高效率，急诊科使用专门的观察单元来管理那些无法出院回家但又明显不需要住院治疗的患者。然而，针对这种情况和患者群体，尚未制定运营指标及其理想目标。此前尚未报道过不同国家这些指标的差异。本研究旨在定义并比较美国三家急诊科观察单元与亚洲三家急诊科观察单元之间的关键运营特征。
这是一项对六家三级医疗机构的描述性研究，所有这些机构均为一级创伤中心，且观察单元由急诊科工作人员管理。我们通过多种方法收集数据，包括标准化调查、直接观察以及与单元负责人的访谈，并对各大洲的数据进行比较。
我们定义了多个关键运营特征以在不同地点之间进行比较，包括观察单元住院时长、观察单元出院率和床位周转率。美国和亚洲观察单元的住院时长平均分别为12.9小时（95%置信区间，8.3至17.5）和20.5小时（95%置信区间，-49.4至90.4）（P = 0.39）。美国和亚洲观察单元的出院率平均分别为84.3%（95%置信区间，81.5至87.2）和88.7%（95%置信区间，81.5至95.8）（P = 0.11），美国和亚洲观察单元的床位周转率平均分别为1.6患者/床位/天（95%置信区间，-0.1至3.3）和0.9患者/床位/天（95%置信区间，-0.6至2.4）（P = 0.27）。
先前的研究表明，观察单元是一种资源，可以缓解急诊科和医院的许多问题，同时提高患者护理质量和满意度。我们描述了与所有观察单元相关的关键运营特征，无论地理位置或医疗系统如何，以监测并最大化效率。尽管美国和亚洲观察单元的住院时长和床位周转率测量值差异很大，但我们未发现统计学上的显著差异。使用这些指标可能使医院能够建立或修订急诊科观察单元，并减少观察单元住院时长、提高床位周转率和出院率，同时提高患者满意度和护理质量。
