急性心肌梗死患者在急诊科的周末就诊情况及死亡率
Emergency Department Weekend Presentation and Mortality in Patients With Acute Myocardial Infarction.
作者信息
de Cordova Pamela B, Johansen Mary L, Martinez Miguel E, Cimiotti Jeannie P
机构信息
Pamela B. de Cordova, PhD, RN-BC, is Assistant Professor of Nursing, Rutgers, the State University of New Jersey, New Brunswick, and Research Faculty, New Jersey Collaborating Center for Nursing, Newark. Mary L. Johansen, PhD, NE-BC, is Clinical Associate Professor, Rutgers, the State University of New Jersey, New Brunswick, and Associate Director, New Jersey Collaborating Center for Nursing, Newark. Miguel E. Martinez, MA, is Senior Institutional Research Analyst, Emory University, Atlanta, Georgia. Jeannie P. Cimiotti, PhD, RN, FAAN, is Associate Professor and Dorothy M. Smith Endowed Chair Director, Florida Blue Center for Health Care Quality, University of Florida College of Nursing, Gainesville.
出版信息
Nurs Res. 2017 Jan/Feb;66(1):20-27. doi: 10.1097/NNR.0000000000000196.
BACKGROUND
Patients admitted to acute care hospitals on weekends have poorer outcomes than those admitted on weekdays, and patients admitted to hospitals for acute myocardial infarction (AMI) on weekends have a higher mortality rate than those admitted during the week. Very few studies have examined weekend presentation for patients with AMI with respect to mortality in the emergency department (ED).
OBJECTIVE
The purpose of this research was to determine if weekend and holiday presentation is associated with increased mortality in EDs among patients with AMI in New Jersey.
METHODS
A retrospective cohort and three data sources representing all hospitals in New Jersey, including patients 18-90 years of age who presented to the ED with symptoms of AMI from January 1, 2008 to January 31, 2010, were used. "Weekend" was defined as Saturday and Sunday, and "holiday" was defined as one of the six major U.S. holidays. Propensity score matching with probit regression was used to estimate the unbiased treatment effect of weekend/holiday presentation on mortality in the ED.
RESULTS
A total of 1,343 patients with a diagnosis of AMI presented to 73 EDs in New Jersey. Of these, 382 (28%) presented on a weekend/holiday and 961 (72%) during weekday hours. After propensity score matching and using probit regression, weekend/holiday presentation was significantly associated with mortality (b = 0.30, 95% CI [0.03, 0.57]). Other statistically significant covariates include patient age (b = 0.03, 95% CI [0.02, 0.04], hospital technology status (b = 0.75, 95% CI [0.20, 1.30]), and nurse staffing (b = -0.08, 95% CI [-0.13, -0.04]).
DISCUSSION
Weekend/holiday presentation to the ED for AMI was associated with increased mortality. The effect may be related to the limited availability of resources on weekend/holidays compared to weekdays. Future studies should examine potential variations of resources, nursing workload, and education and expertise of healthcare providers in the ED during the weekend.
背景
周末入住急症医院的患者比工作日入院的患者预后更差，且周末因急性心肌梗死（AMI）入院的患者死亡率高于一周内其他时间入院的患者。很少有研究探讨过AMI患者在急诊科（ED）就诊的时间（周末或节假日）与死亡率之间的关系。
目的
本研究旨在确定新泽西州AMI患者在急诊科就诊的时间为周末或节假日是否与死亡率增加有关。
方法
采用回顾性队列研究，并利用代表新泽西州所有医院的三个数据源，纳入2008年1月1日至2010年1月31日期间因AMI症状就诊于急诊科的18至90岁患者。“周末”定义为周六和周日，“节假日”定义为美国六个主要节假日之一。使用倾向得分匹配法和概率单位回归来估计周末/节假日就诊对急诊科死亡率的无偏治疗效果。
结果
新泽西州73家急诊科共有1343例诊断为AMI的患者。其中，382例（28%）在周末/节假日就诊，961例（72%）在工作日就诊。经过倾向得分匹配并使用概率单位回归后，周末/节假日就诊与死亡率显著相关（b = 0.30，95%置信区间[0.03, 0.57]）。其他具有统计学意义的协变量包括患者年龄（b = 0.03，95%置信区间[0.02, 0.04]）、医院技术水平（b = 0.75，95%置信区间[0.20, 1.30]）和护士配备情况（b = -0.08，95%置信区间[-0.13, -0.04]）。
讨论
因AMI在急诊科周末/节假日就诊与死亡率增加有关。这种影响可能与周末/节假日相比工作日资源有限有关。未来的研究应探讨急诊科在周末期间资源、护理工作量以及医护人员教育和专业知识的潜在差异。
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