Shetty Amith L, Teh Caleb, Vukasovic Matthew, Joyce Shannon, Vaghasiya Milan R, Forero Roberto
Emergency Department, Westmead Hospital, Sydney, New South Wales, Australia.
Sydney Medical School - Westmead Campus, The University of Sydney, Sydney, New South Wales, Australia.
Emerg Med Australas. 2017 Aug;29(4):407-414. doi: 10.1111/1742-6723.12777. Epub 2017 Apr 16.
The ED discharge stream short stay units (EDSSUs) aim to facilitate patient flows through EDs. We investigate the relationship between EDSSU census and hospital bed occupancy rates (BORs) on National Emergency Access Target (NEAT) performance and did-not-wait (DNW) rates at a tertiary metropolitan adult ED in Sydney, Australia.
We collated data for all ED presentations between 1 January 2012 and 31 December 2014. Daily ED, EDSSU census and ED-accessible hospital BORs were tabulated with daily ED NEAT performance and DNW rates. Non-parametric regression analyses was conducted on cohorts of appropriate, inappropriate, successful and failed EDSSU admissions based on local admission policies and BOR for NEAT and DNW outcomes.
Among all presentations (n = 192 506) during the study period, 43.8% of patients were admitted in hospital including 10.4% for EDSSU (n = 20 081). Analyses reveal modest positive correlation of EDSSU admissions with NEAT performance (τ = 0.35, P < 0.001) and weak negative correlation with DNW rates (τ = -0.29, P < 0.001). These associations were more pronounced on days when BOR >100% (τ = 0.39 and τ = -0.36, P < 0.001). BOR of >100% were associated with reduced EDSSU admits, NEAT performance and increased DNW rates (P < 0.001). Appropriate EDSSU admissions had shorter EDSSU length of stay than inappropriate EDSSU admissions (350 vs 557 min, median difference -158 min, P < 0.001).
Appropriate use of EDSSU provides effective conduit for ongoing patients' management beyond mandated timelines. Health systems should focus on reducing hospital BORs to mitigate exclusive ED pressure to deliver NEAT performance targets.
急诊科出院分流短留单元（EDSSU）旨在促进患者在急诊科的流动。我们调查了澳大利亚悉尼一家三级城市成人急诊科中，EDSSU普查人数与医院床位占用率（BOR）对国家紧急就诊目标（NEAT）绩效和未等待（DNW）率的影响。
我们整理了2012年1月1日至2014年1月31日期间所有急诊科就诊的数据。将每日急诊科、EDSSU普查人数和可使用急诊科的医院BOR与每日急诊科NEAT绩效和DNW率制成表格。根据当地入院政策和BOR，对适当、不适当、成功和失败的EDSSU入院队列进行非参数回归分析，以得出NEAT和DNW结果。
在研究期间的所有就诊患者（n = 192506）中，43.8%的患者入院治疗，其中10.4%在EDSSU（n = 20081）。分析显示，EDSSU入院人数与NEAT绩效呈适度正相关（τ = 0.35，P < 0.001），与DNW率呈弱负相关（τ = -0.29，P < 0.001）。当BOR > 100%时，这些关联更为明显（τ = 0.39和τ = -0.36，P < 0.001）。BOR > 100%与EDSSU入院人数减少、NEAT绩效降低和DNW率增加相关（P < 0.001）。适当的EDSSU入院患者在EDSSU的住院时间比不适当的EDSSU入院患者短（350分钟对557分钟，中位数差异-158分钟，P < 0.001）。
合理使用EDSSU为超出规定时间的患者持续管理提供了有效途径。卫生系统应专注于降低医院BOR，以减轻急诊科的独家压力，实现NEAT绩效目标。
