七月效应：在医院学年开始时急诊科的住院时间会更长吗？
The July Effect: is emergency department length of stay greater at the beginning of the hospital academic year?
作者信息
Riguzzi Christine, Hern H Gene, Vahidnia Farnaz, Herring Andrew, Alter Harrison
机构信息
Highland Hospital, Alameda Health System, Oakland, California.
出版信息
West J Emerg Med. 2014 Feb;15(1):88-93. doi: 10.5811/westjem.2013.10.18123.
INTRODUCTION
There has been concern of increased emergency department (ED) length of stay (LOS) during the months when new residents are orienting to their roles. This so-called "July Effect" has long been thought to increase LOS, and potentially contribute to hospital overcrowding and increased waiting time for patients. The objective of this study is to determine if the average ED LOS at the beginning of the hospital academic year differs for teaching hospitals with residents in the ED, when compared to other months of the year, and as compared to non-teaching hospitals without residents.
METHODS
We performed a retrospective analysis of a nationally representative sample of 283,621 ED visits from the National Hospital Ambulatory Medical Care Survey (NHAMCS), from 2001 to 2008. We stratified the sample by proportion of visits seen by a resident, and compared July to the rest of the year, July to June, and July and August to the remainder of the year. We compared LOS for teaching hospitals to non-teaching hospitals. We used bivariate statistics, and multivariable regression modeling to adjust for covariates.
RESULTS
Our findings show that at teaching hospitals with residents, there is no significant difference in mean LOS for the month of July (275 minutes) versus the rest of the year (259 min), July and August versus the rest of the year, or July versus June. Non-teaching hospital control samples yielded similar results with no significant difference in LOS for the same time periods. There was a significant difference found in mean LOS at teaching hospitals (260 minutes) as compared to non-teaching hospitals (185 minutes) throughout the year (p<0.0001).
CONCLUSION
Teaching hospitals with residents in the ED have slower throughput of patients, no matter what time of year. Thus, the "July Effect" does not appear to a factor in ED LOS. This has implications as overcrowding and patient boarding become more of a concern in our increasingly busy EDs. These results question the need for additional staffing early in the academic year. Teaching hospitals may already institute more robust staffing during this time, preventing any significant increase in LOS. Multiple factors contribute to long stays in the ED. While patients seen by residents stay longer in the ED, there is little variability throughout the academic year.
引言
人们一直担心在新住院医师适应其角色的月份里，急诊科（ED）的住院时间（LOS）会增加。这种所谓的“七月效应”长期以来一直被认为会延长住院时间，并可能导致医院过度拥挤以及患者等待时间增加。本研究的目的是确定与一年中的其他月份相比，以及与没有住院医师的非教学医院相比，在医院学年开始时，有住院医师在急诊科的教学医院的平均急诊科住院时间是否有所不同。
方法
我们对2001年至2008年全国医院门诊医疗调查（NHAMCS）中具有全国代表性的283,621例急诊科就诊样本进行了回顾性分析。我们根据住院医师诊治的就诊比例对样本进行分层，并将7月与一年中的其他时间、7月与6月、7月和8月与一年中的其余时间进行比较。我们比较了教学医院和非教学医院的住院时间。我们使用双变量统计和多变量回归模型来调整协变量。
结果
我们的研究结果表明，在有住院医师的教学医院中，7月份的平均住院时间（275分钟）与一年中的其他时间（259分钟）、7月和8月与一年中的其他时间、7月与6月之间均无显著差异。非教学医院对照样本得出了类似的结果，相同时间段内的住院时间也无显著差异。全年来看，教学医院的平均住院时间（260分钟）与非教学医院（185分钟）相比存在显著差异（p<0.0001）。
结论
无论一年中的什么时候，有住院医师在急诊科的教学医院患者周转速度都较慢。因此，“七月效应”似乎不是影响急诊科住院时间的一个因素。随着在日益繁忙的急诊科中过度拥挤和患者滞留问题变得更加令人担忧，这具有重要意义。这些结果质疑了在学年早期增加人员配备的必要性。教学医院在此期间可能已经制定了更强有力的人员配备计划，从而防止住院时间出现任何显著增加。急诊科住院时间长有多种因素。虽然由住院医师诊治的患者在急诊科停留的时间更长，但在整个学年中变化不大。
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