Huang I-Anne, Tuan Pao-Lan, Jaing Tang-Her, Wu Chang-Teng, Chao Minston, Wang Hui-Hsuan, Hsia Shao-Hsuan, Hsiao Hsiang-Ju, Chang Yu-Ching
Department of Pediatrics, Chang Gung Memorial Hospital at Keelung, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Pediatr Neonatol. 2016 Oct;57(5):371-377. doi: 10.1016/j.pedneo.2015.10.005. Epub 2015 Dec 8.
Pediatric emergency medicine is a young field that has established itself in recent decades. Many unanswered questions remain regarding how to deliver better pediatric emergency care. The implementation of full-time pediatric emergency physicians is a quality improvement strategy for child care in Taiwan. The aim of this study is to evaluate the quality of care under different physician coverage models in the pediatric emergency department (ED).
The medical records of 132,398 patients visiting the pediatric ED of a tertiary care university hospital during January 2004 to December 2006 were retrospectively reviewed. Full-time pediatric emergency physicians are the group specializing in the pediatric emergency medicine, and they only work in the pediatric ED. Part-time pediatricians specializing in other subspecialties also can work an extra shift in the pediatric ED, with the majority working in their inpatient and outpatient services. We compared quality performance indicators, including: mortality rate, the 72-hour return visit rate, length of stay, admission rate, and the rate of being kept for observation between full-time and part-time pediatric emergency physicians.
An average of 3678 ± 125 [mean ± standard error (SE)] visits per month (with a range of 2487-6646) were observed. The trends in quality of care, observed monthly, indicated that the 72-hour return rate was 2-6% and length of stay in the ED decreased from 11.5 hours to 3.2 hours over the study period. The annual mortality rate within 48 hours of admission to the ED increased from 0.04% to 0.05% and then decreased to 0.02%, and the overall mortality rate dropped from 0.13% to 0.07%. Multivariate analyses indicated that there was no change in the 72-hour return visit rate for full-time pediatric emergency physicians; they were more likely to admit and keep patients for observation [odds ratio = 1.43 and odds ratio = 1.71, respectively], and these results were similar to those of senior physicians.
Full-time pediatric emergency physicians in the pediatric ED decreased the mortality rate and length of stay in the ED, but had no change in the 72-hour return visit rate. This pilot study shows that the quality of care in pediatric ED after the implementation of full-time pediatric emergency physicians needs further evaluation.
儿科急诊医学是一个在近几十年才得以确立的年轻领域。关于如何提供更好的儿科急诊护理，仍存在许多未解决的问题。在台湾，配备全职儿科急诊医生是改善儿童护理的一项质量改进策略。本研究旨在评估儿科急诊科（ED）在不同医生配置模式下的护理质量。
回顾性分析了2004年1月至2006年12月期间一家三级医疗大学医院儿科急诊就诊的132398例患者的病历。全职儿科急诊医生是专门从事儿科急诊医学的群体，他们只在儿科急诊科工作。其他专科的兼职儿科医生也可以在儿科急诊科额外排班，其中大多数人在其住院和门诊服务部门工作。我们比较了质量绩效指标，包括：死亡率、72小时复诊率、住院时间、住院率以及全职和兼职儿科急诊医生之间的留观率。
每月平均观察到3678±125[均值±标准误（SE）]次就诊（范围为2487 - 6646次）。每月观察到的护理质量趋势表明，72小时复诊率为2% - 6%，在研究期间，急诊科的住院时间从11.5小时降至3.2小时。急诊入院后48小时内的年死亡率从0.04%升至0.05%，然后降至0.02%，总体死亡率从0.13%降至0.07%。多变量分析表明，全职儿科急诊医生的72小时复诊率没有变化；他们更有可能收治患者并留观[优势比分别为1.43和1.71]，这些结果与高级医生的结果相似。
儿科急诊科的全职儿科急诊医生降低了死亡率和急诊科住院时间，但72小时复诊率没有变化。这项初步研究表明，实施全职儿科急诊医生后，儿科急诊科的护理质量需要进一步评估。
