Silvester Kate, Harriman Paul, Walley Paul, Burley Glen
Int J Health Care Qual Assur. 2014;27(7):616-32. doi: 10.1108/ijhcqa-09-2013-0115.
The purpose of the paper is to investigate the potential relationships between emergency-care flow, patient mortality and healthcare costs using a patient-flow model.
DESIGN/METHODOLOGY/APPROACH: The researchers used performance data from one UK NHS trust collected over three years to identify periods where patient flow was compromised. The delays' root causes in the entire emergency care system were investigated. Event time-lines that disrupted patient flow and patient mortality statistics were compared.
Data showed that patient mortality increases at times when accident and emergency (A&E) department staff were struggling to admit patients. Four delays influenced mortality: first, volume increase and mixed admissions; second, process delays; third, unplanned hospital capacity adjustments and finally, long-term capacity restructuring downstream.
RESEARCH LIMITATIONS/IMPLICATIONS: This is an observational study that uses process control data to find times when mortality increases coincide with other events. It captures contextual background to whole system issues that affect patient mortality.
Managers must consider cost-decisions and flow in the whole system. Localised, cost-focused decisions can have a detrimental effect on patient care. Attention must also be paid to mortality reports as existing data-presentation methods do not allow correlation analysis.
ORIGINALITY/VALUE: Previous studies correlate A&E overcrowding and mortality. This method allows the whole system to be studied and increased mortality root causes to be understood.
本文旨在使用患者流模型研究急诊流程、患者死亡率和医疗成本之间的潜在关系。
设计/方法/途径：研究人员使用了英国一家国民健康服务信托机构在三年时间里收集的绩效数据，以确定患者流受到影响的时期。对整个急诊系统中延误的根本原因进行了调查。比较了扰乱患者流的事件时间线和患者死亡率统计数据。
数据显示，当急症室（A&E）工作人员难以收治患者时，患者死亡率会上升。有四个延误因素影响了死亡率：第一，数量增加和混合收治；第二，流程延误；第三，计划外的医院容量调整；最后，下游的长期容量重组。
研究局限性/启示：这是一项观察性研究，使用过程控制数据来找出死亡率上升与其他事件同时发生的时期。它捕捉了影响患者死亡率的整个系统问题的背景情况。
管理人员必须考虑整个系统中的成本决策和流程。局部的、以成本为重点的决策可能会对患者护理产生不利影响。还必须关注死亡率报告，因为现有的数据呈现方法不允许进行相关性分析。
原创性/价值：以往的研究将急症室拥挤与死亡率联系起来。这种方法可以对整个系统进行研究，并了解死亡率上升的根本原因。
