Bernard Kenneth, Hasegawa Kohei, Sullivan Ashley, Camargo Carlos
Department of Emergency Medicine, Tuba City Regional Health Care Corp, Tuba City, AZ.
Department of Emergency Medicine and Emergency Medicine Network (EMNet), Massachusetts General Hospital, Boston, MA.
Ann Emerg Med. 2017 Jun;69(6):705-710.e4. doi: 10.1016/j.annemergmed.2016.11.031. Epub 2017 Jan 19.
The Indian Health Service provides health care to eligible American Indians and Alaskan Natives. No published data exist on emergency services offered by this unique health care system. We seek to determine the characteristics and capabilities of Indian Health Service emergency departments (EDs).
All Indian Health Service EDs were surveyed about demographics and operational characteristics for 2014 with the National Emergency Department Inventory survey (available at http://www.emnet-nedi.org/).
Of the forty eligible sites, there were 34 respondents (85% response rate). Respondents reported a total of 637,523 ED encounters, ranging from 521 to 63,200 visits per site. Overall, 85% (95% confidence interval 70% to 94%) had continuous physician coverage. Of all physicians staffing the ED, a median of 13% (interquartile range 0% to 50%) were board certified or board prepared in emergency medicine. Overall, 50% (95% confidence interval 34% to 66%) of respondents reported that their ED was operating over capacity.
Indian Health Service EDs varied widely in visit volume, with many operating over capacity. Most were not staffed by board-certified or -prepared emergency physicians. Most lacked access to specialty consultation and telemedicine capabilities.
印第安卫生服务部为符合条件的美国印第安人和阿拉斯加原住民提供医疗保健服务。关于这个独特的医疗保健系统所提供的急诊服务，尚无已发表的数据。我们试图确定印第安卫生服务部急诊科的特征和能力。
利用国家急诊科库存调查（可在http://www.emnet-nedi.org/获取）对所有印第安卫生服务部的急诊科进行了2014年人口统计学和运营特征方面的调查。
在40个符合条件的机构中，有34个机构做出了回应（回应率为85%）。回应者报告的急诊科就诊总数为637,523人次，每个机构的就诊人次从521到63,200不等。总体而言，85%（95%置信区间为70%至94%）有持续的医生值班。在所有在急诊科工作的医生中，有13%（四分位距为0%至50%）的医生拥有急诊医学专业认证或正在接受相关培训。总体而言，50%（95%置信区间为34%至66%）的回应者报告称他们的急诊科处于超负荷运转状态。
印第安卫生服务部的急诊科就诊量差异很大，许多处于超负荷运转状态。大多数急诊科没有配备获得专业认证或正在接受相关培训的急诊医生。大多数急诊科无法获得专科会诊和远程医疗服务。
