Kim S W, Horwood C, Li J Y, Hakendorf P H, Teubner D J O, Thompson C H
Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Adelaide, South Australia, Australia.
Clinical Epidemiology Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.
Intern Med J. 2015 Dec;45(12):1241-7. doi: 10.1111/imj.12918.
Streaming occurs in emergency department (ED) to reduce crowding, but misallocation of patients may impact patients' outcome.
The study aims to determine the outcomes of patients misallocated by the ED process of streaming into likely admission or discharge.
This is a retrospective cohort study, at an Australian, urban, tertiary referral hospital's ED between January 2010 and March 2012, using propensity score matching for comparison. Total and partitioned ED lengths of stay, inpatient length of stay, in-hospital mortality and 7- and 28-day unplanned readmission rate were compared between patients who were streamed to be admitted against those streamed to be discharged.
Total ED length of stay did not differ significantly for admitted patients if allocated to the wrong stream (median 7.6 h, interquartile range 5.7-10.6, cf. 7.5 h, 5.3-11.2; P = 0.34). The median inpatient length of stay was shorter for those initially misallocated to the discharge stream (1.8 days, 1.1-3.0, cf. 2.4 days, 1.4-3.9; P < 0.001). In-hospital mortality and 7- and 28-day readmission rates were not adversely affected by misallocation. When considering patients eventually discharged from the ED, those allocated to the wrong stream stayed in the ED longer than those appropriately allocated (5.2 h, 3.7-7.3, cf. 4.6 h, 3.3-6.4; P < 0.001).
There were no significant adverse consequences for an admitted patient initially misallocated by an ED admission/discharge streaming process. Patients' discharge from the ED was slower if they had been allocated to the admission stream. Streaming carries few risks for patients misallocated by such a process.
在急诊科采用分流措施以减少拥挤情况，但患者分配不当可能会影响患者的治疗结果。
本研究旨在确定因急诊科分流流程而被错误分配至可能入院或出院的患者的治疗结果。
这是一项回顾性队列研究，研究对象为2010年1月至2012年3月期间澳大利亚一家城市三级转诊医院急诊科的患者，采用倾向得分匹配法进行比较。比较了被分流至入院组和出院组患者的急诊科总住院时间和分段住院时间、住院时间、院内死亡率以及7天和28天非计划再入院率。
若将应入院患者错误分配，其急诊科总住院时间无显著差异（中位数7.6小时，四分位间距5.7 - 10.6，对比7.5小时，5.3 - 11.2；P = 0.34）。最初被错误分配至出院组的患者住院时间中位数较短（1.8天，1.1 - 3.0，对比2.4天，1.4 - 3.9；P < 0.001）。分配不当对院内死亡率以及7天和28天再入院率无不利影响。在考虑最终从急诊科出院的患者时，被错误分配的患者在急诊科停留的时间比分配恰当的患者更长（5.2小时，3.7 - 7.3，对比4.6小时，3.3 - 6.4；P < 0.001）。
对于因急诊科入院/出院分流流程而最初被错误分配的入院患者，没有显著的不良后果。若患者被分配至入院组，其从急诊科出院的速度较慢。通过这种流程被错误分配的患者，分流带来的风险较小。
