Brouns Steffie H A, van der Schuit Klara C H, Stassen Patricia M, Lambooij Suze L E, Dieleman Jeanne, Vanderfeesten Irene T P, Haak Harm R
Department of Internal Medicine, Máxima Medical Centre, Eindhoven/Veldhoven, the Netherlands.
Department of Internal Medicine, division of general medicine, section acute medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.
PLoS One. 2017 Mar 10;12(3):e0173387. doi: 10.1371/journal.pone.0173387. eCollection 2017.
Emergency department (ED) crowding leads to prolonged emergency department length of stay (ED-LOS) and adverse patient outcomes. No uniform definition of ED crowding exists. Several scores have been developed to quantify ED crowding; the best known is the Emergency Department Work Index (EDWIN). Research on the EDWIN is often applied to limited settings and conducted over a short period of time.
To explore whether the EDWIN as a measure can track occupancy at a Dutch ED over the course of one year and to identify fluctuations in ED occupancy per hour, day, and month. Secondary objective is to investigate the discriminatory value of the EDWIN in detecting crowding, as compared with the occupancy rate and prolonged ED-LOS.
A retrospective cohort study of all ED visits during the period from September 2010 to August 2011 was performed in one hospital in the Netherlands. The EDWIN incorporates the number of patients per triage level, physicians, treatment beds and admitted patients to quantify ED crowding. The EDWIN was adjusted to emergency care in the Netherlands: modified EDWIN (mEDWIN). ED crowding was defined as the 75th percentile of mEDWIN per hour, which was ≥0.28.
In total, 28,220 ED visits were included in the analysis. The median mEDWIN per hour was 0.15 (Interquartile range (IQR) 0.05-0.28); median mEDWIN per patient was 0.25 (IQR 0.15-0.39). The EDWIN was higher on Wednesday (0.16) than on other days (0.14-0.16, p<0.001), and a peak in both mEDWIN (0.30-0.33) and ED crowding (52.9-63.4%) was found between 13:00-18:00 h. A comparison of the mEDWIN with the occupancy rate revealed an area under the curve (AUC) of 0.86 (95%CI 0.85-0.87). The AUC of mEDWIN compared with a prolonged ED-LOS (≥4 hours) was 0.50 (95%CI 0.40-0.60).
The mEDWIN was applicable at a Dutch ED. The mEDWIN was able to identify fluctuations in ED occupancy. In addition, the mEDWIN had high discriminatory power for identification of a busy ED, when compared with the occupancy rate.
急诊科拥挤会导致急诊科住院时间延长（ED-LOS）以及不良的患者预后。目前尚无统一的急诊科拥挤定义。已开发出多种评分来量化急诊科拥挤程度；其中最知名的是急诊科工作指数（EDWIN）。关于EDWIN的研究通常应用于有限的环境，且时间较短。
探讨作为一种测量方法的EDWIN能否在一年时间内追踪荷兰一家急诊科的占用情况，并识别每小时、每天和每月急诊科占用情况的波动。次要目的是与占用率和延长的ED-LOS相比，研究EDWIN在检测拥挤方面的鉴别价值。
对荷兰一家医院2010年9月至2011年8月期间所有急诊科就诊病例进行回顾性队列研究。EDWIN纳入了每个分诊级别、医生、治疗床位和入院患者的数量，以量化急诊科拥挤程度。对EDWIN进行了调整以适用于荷兰的急诊护理：改良的EDWIN（mEDWIN）。急诊科拥挤定义为每小时mEDWIN的第75百分位数，即≥0.28。
分析共纳入28220例急诊科就诊病例。每小时mEDWIN的中位数为0.15（四分位间距（IQR）0.05 - 0.28）；每位患者mEDWIN的中位数为0.25（IQR 0.15 - 0.39）。周三的EDWIN（0.16）高于其他日期（0.14 - 0.16，p<0.001），且在13:00 - 18:00之间发现mEDWIN（0.30 - 0.33）和急诊科拥挤程度（52.9 - 63.4%）均出现峰值。mEDWIN与占用率的比较显示曲线下面积（AUC）为0.86（95%CI 0.85 - 0.87）。mEDWIN与延长的ED-LOS（≥4小时）相比的AUC为0.50（95%CI 0.40 - 0.60）。
mEDWIN适用于荷兰的一家急诊科。mEDWIN能够识别急诊科占用情况的波动。此外，与占用率相比，mEDWIN在识别繁忙的急诊科方面具有较高的鉴别力。
