Madavan Nambiar K T, Nedungalaparambil Nisanth Menon, Aslesh Ottapura Prabhakaran
Department of Emergency Medicine, Academy of Medical Sciences, Kannur, Kerala, India.
Department of Community Medicine, Academy of Medical Sciences, Kannur, Kerala, India.
J Emerg Trauma Shock. 2017 Jul-Sep;10(3):121-127. doi: 10.4103/JETS.JETS_139_16.
Resource limitation, staff deficiency, and variability in patient inflow contribute to emergency department (ED) overcrowding, associated with delayed care, poor care, and poor patient outcomes. This study seeks to describe and analyze patient inflow variability and staffing trends on Sundays versus other days in a tertiary academic ED from South India.
Patient inflow and staffing data for 2 years were collected from hospital records, cross-checked, and statistically analyzed using Epi Info 7.0.
Significant increase in patient inflow (45.6%) was noted on Sundays compared to other days (155.9 [95% confidence interval (CI): 152.75-159.05] vs. 107.1 [95% CI: 105.98-108.22]; < 0.001), with higher inflow in the morning shifts (67.4 [95% CI: 65.41-69.45] vs. 32.1 [95% CI: 31.45-32.70]; < 0.001). All categories of ED staff were deficient across all shifts (2.1 [95% CI: 2.05-2.15] tier-2 physicians, 4.9 [95% CI: 4.86-4.94] nurses, and 1.9 [95% CI: 1.88-1.92] nurse assistants on an average), especially tier-1 physicians (0.3 [95% CI: 0.24-0.36] on Sundays and 0.5 [95% CI: 0.48-0.52] on other days; < 0.001). Patient-per-hour (PPH)-per-provider based on patient arrival rate was generally high. PPH per tier-1 physician was the highest, being 10.6 (95% CI: 9.95-11.14) versus 5.4 (95% CI: 5.26-5.59; < 0.001) in the morning and 7.2 (95% CI: 6.95-7.45) versus 6.6 (95% CI: 6.43-6.74; = 0.08) in the evening shifts on Sundays and other days, respectively.
There were deficiencies in all categories of ED staff on all days, and this was pronounced on Sundays due to significantly higher patient inflow. Inadequate ED staffing, especially due to a significant dearth of tier-1 physicians is a pointer toward quality compromise in developing EDs. Authors recommend adequate staff deployment in developing EDs for optimum quality care. This should be implemented such that staffing is based on expected patient inflow so that a PPH-per-provider goal of 2.5 is targeted across all shifts.
资源限制、人员短缺以及患者流入的可变性导致急诊科过度拥挤，进而引发护理延迟、护理质量差以及患者预后不良。本研究旨在描述和分析印度南部一家三级学术性急诊科周日与其他日子的患者流入可变性及人员配备趋势。
从医院记录中收集了两年的患者流入和人员配备数据，进行交叉核对，并使用Epi Info 7.0进行统计分析。
与其他日子相比，周日的患者流入量显著增加（45.6%）（155.9[95%置信区间（CI）：152.75 - 159.05]对107.1[95%CI：105.98 - 108.22]；<0.001），早班的流入量更高（67.4[95%CI：65.41 - 69.45]对32.1[95%CI：31.45 - 32.70]；<0.001）。所有班次的急诊科各类工作人员均短缺（平均2.1[95%CI：2.05 - 2.15]名二级医生、4.9[95%CI：4.86 - 4.94]名护士和1.9[95%CI：1.88 - 1.92]名护士助理），尤其是一级医生（周日为0.3[95%CI：0.24 - 0.36]名，其他日子为0.5[95%CI：0.48 - 0.52]名；<0.001）。基于患者到达率的每小时每位医护人员的患者量（PPH）普遍较高。一级医生的PPH最高，周日早班为10.6（95%CI：9.95 - 11.14），其他日子为5.4（95%CI：5.26 - 5.59；<0.001）；周日晚班为7.2（95%CI：6.95 - 7.45），其他日子为6.6（95%CI：6.43 - 6.74；=0.08）。
所有日子里急诊科各类工作人员均有短缺，周日因患者流入量显著更高而更为明显。急诊科人员配备不足，尤其是一级医生严重短缺，表明发展中的急诊科护理质量可能受损。作者建议在发展中的急诊科进行充分的人员部署以实现最佳护理质量。应根据预期的患者流入量进行人员配备，以使所有班次每小时每位医护人员的患者量目标达到2.5。
