法国急诊科出院患者住院时间的相关因素。
Factors associated with the length of stay of patients discharged from emergency department in France.
作者信息
Capuano Frédéric, Lot Anne-Sophie, Sagnes-Raffy Christine, Ferrua Marie, Brun-Ney Dominique, Leleu Henri, Pateron Dominique, Debaty Guillaume, Giroud Marc, Minvielle Etienne, Riou Bruno
机构信息
aManagement in Health Services Research Department, Ecole des Hautes Etudes en Santé Publique (EHESP), Institut Gustave Roussy, Villejuif bObservatoire des Urgences Midi-Pyrénées (ORU-MiP), Toulouse cMedical Headquarter, Assistance-Publique Hôpitaux de Paris (APHP) dEmergency Department, Centre Hospitalo-Universitaire (CHU) Saint Antoine, APHP, Université Pierre et Marie Curie (UPMC), Paris eEmergency Department, CHU Pitié-Salpêtrière, APHP, UPMC, Paris fPrehospital Emergency Department, SAMU 38, CHU de Grenoble, Grenoble gPrehospital Emergency Department, SAMU 95, Hôpital de Pontoise, Pontoise, France.
出版信息
Eur J Emerg Med. 2015 Apr;22(2):92-8. doi: 10.1097/MEJ.0000000000000109.
OBJECTIVES
The length of stay in the emergency department (ED) has been proposed as an indicator of performance in many countries. We conducted a survey of length of stay in two large areas in France and tested the hypothesis that patient and ED-related variables may influence it.
PATIENTS AND METHODS
During 2007, we examined lengths of stay in ambulatory patients, that is, excluding admitted patients. The following variables were considered: (a) at the patient level, age, sex, the day and month of the visit, and the French clinical classification of emergency patients (CCEP) class; (b) at the ED level, annual ED total number of visits, mean age, the proportions of patients less than 15 and more than 75 years, and the proportions of admitted and clinically stable patients with CCEP class 1 and 2. A multilevel hierarchical analysis was carried out.
RESULTS
We analyzed 988 591 visits in 53 EDs. The ED-specific median length of stay was 98 (IQR: 62-137) min and the ED-specific median proportion of patients with length of stay of more than 4 h was 15 (5-24) %. There was a strong correlation between the ED-specific median length of stay and the ED-specific proportion of patients with a length of stay of more than 4 h (R=0.96, P<0.001). Using a multilevel analysis, only three variables were associated significantly with the length of stay: the age and the CCEP class of the patient, and the ED census.
CONCLUSION
We observed that the length of stay in the ED needs to be stratified by case mix and the total number of visits of the ED.
目的
在许多国家，急诊科（ED）的住院时间已被提议作为一项绩效指标。我们对法国两个大区域的住院时间进行了一项调查，并检验了患者及与急诊科相关的变量可能会对其产生影响这一假设。
患者与方法
在2007年期间，我们研究了非住院患者（即不包括已收治患者）的住院时间。考虑了以下变量：（a）患者层面的年龄、性别、就诊日期和月份，以及法国急诊患者临床分类（CCEP）类别；（b）急诊科层面的年度急诊就诊总数、平均年龄、15岁以下和75岁以上患者的比例，以及CCEP 1类和2类已收治且临床稳定患者的比例。进行了多层次分层分析。
结果
我们分析了53个急诊科的988591次就诊情况。各急诊科的住院时间中位数为98（四分位间距：62 - 137）分钟，各急诊科住院时间超过4小时患者的中位数比例为15（5 - 24）%。各急诊科住院时间中位数与各急诊科住院时间超过4小时患者的比例之间存在强相关性（R = 0.96，P < 0.001）。使用多层次分析，只有三个变量与住院时间显著相关：患者的年龄、CCEP类别以及急诊科普查人数。
结论
我们观察到，急诊科的住院时间需要按病例组合和急诊科就诊总数进行分层。
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