将急性转诊重新安排至急诊科，使得慢性阻塞性肺疾病的入院人数减少，但无创通气率提高。

Reorganisation of acute referral to an emergency department resulted in fewer admissions for chronic obstructive pulmonary disease but in higher rates of non-invasive ventilation.

作者信息

Titlestad Ingrid Louise, Bryde Jonas, Øberg-Hansen Bo, Lassen Annmarie Touborg, Vestbo Jørgen

机构信息

Lungemedicinsk Afdeling, Odense Universitetshospital, Sdr. Boulevard 29, 5000 Odense, Denmark.

出版信息

Dan Med J. 2014 Nov;61(11):A4958.

PMID:25370962

Abstract

INTRODUCTION

We performed an audit on all admissions with chronic obstructive pulmonary disease (COPD) in ex-acerbation to the Department of Emergency Medicine, Odense University Hospital (DEM) in the second half of 2012 to evaluate if an organisational change had altered visitation, treatment, initiation of non-invasive ventilation (NIV) and monitoring. We chose not to include the entire year to avoid data influenced by organisational start-up difficulties. The hypothesis was that NIV was initiated according to guidelines to the same extent as prior to the implementation of DEM.

METHODS

Data from medical records were retrieved from two COPD cohorts: 1) all patients admitted to DEM between 1 July and 31 December 2012 and 2) all patients admitted to the Medical Emergency Ward, Odense University Hospital (MEW) in 2010.

RESULTS

There were 300 eligible admissions comprising 236 unique patients in DEM in the second half of 2012 compared with 393 admissions in MEW in the second half of 2010, a 24% reduction. The groups were similar in gender and age, but patients admitted in 2012 had higher registered co-morbidity rates, but no significant difference in lung function values. NIV was indicated in 91 admissions (30%) and initiated in 58 admissions (19.3%) in 2012. By comparison NIV was indicated in 193 admissions (24%) and initiated in 151 admissions (18.8%) in 2010.

CONCLUSION

There was a statistically significant increase in NIV indication without initiation of treatment in 2012 (28 admissions; 9.3%) compared with 2010 (36 admissions; 4.5%), but no referrals to the intensive care unit or deaths were registered during the hospitalisation in either of the groups, but one patient died within 30 days after admission from the DEM.

FUNDING

This project was funded by an Odense University Hospital research grant.

TRIAL REGISTRATION

The study was approved by the Danish Data Protection Agency (record no. 2011-41-6459).

摘要

引言

我们对2012年下半年奥登塞大学医院急诊科（DEM）收治的所有慢性阻塞性肺疾病（COPD）急性加重患者进行了一次审核，以评估组织变革是否改变了探视、治疗、无创通气（NIV）的启动及监测情况。我们选择不纳入全年数据，以避免受组织启动困难影响的数据。假设是NIV的启动遵循指南的程度与DEM实施前相同。

方法

从两个COPD队列的病历中检索数据：1）2012年7月1日至12月31日期间所有入住DEM的患者；2）2010年所有入住奥登塞大学医院内科急诊病房（MEW）的患者。

结果

2012年下半年DEM有300例符合条件的入院病例，包括236名不同患者，而2010年下半年MEW有393例入院病例，减少了24%。两组在性别和年龄上相似，但2012年入院的患者合并症登记率更高，不过肺功能值无显著差异。2012年有91例入院病例（30%）需要NIV，58例入院病例（19.3%）启动了NIV。相比之下，2010年有193例入院病例（24%）需要NIV，151例入院病例（18.8%）启动了NIV。