Habib Muhammad Irfan, Khan Khalid Mehmood
Child Life Foundation.
National Institute of Child Health, Karachi.
J Pak Med Assoc. 2017 Sep;67(9):1398-1403.
To quantify the extent of emergency department overcrowding in a tertiary care hospital and to identify possible solutions.
This retrospective study was conducted at the National Institute of Child Health, Karachi, and comprised data of all patients presenting to the emergency department from November 2014 to January 2015. Data was collected through the health management information system which generates daily report of patients. Patients who stayed at the emergency department for 4 or more hours were included.
Of the 6,505 patients, 2,757(42.38%) were discharged straightaway while 2,555(39.27%) were admitted to different wards and subspecialties. Besides, 934(14.35%) patients left the department against medical advice, 147(2.25%) expired, 89(1.36%) were referred to other hospitals, 20(0.30%) were dead on arrival and 3(0.04%) left without being seen by a physician. Of those who were admitted, 1,049(41%) patients stayed for more than 10 hours before getting the main hospital bed. Mostly, the delays observed were due to delay in getting lab reports, already preoccupied ventilators and incubators in paediatric and neonatal intensive care units, not using checklist for proper re-assessment of patients and early discharge, overburdened by patients coming in just for nebulisation and intravenous or intramuscular medications, the admitting residents detain the unstable patient longer in emergency department before admission to wards.
The emergency department of the hospital faced significant overcrowding which overwhelmed efficient standard care.
量化一家三级医疗医院急诊科过度拥挤的程度，并确定可能的解决方案。
这项回顾性研究在卡拉奇国家儿童健康研究所进行，纳入了2014年11月至2015年1月期间到急诊科就诊的所有患者的数据。数据通过生成患者每日报告的健康管理信息系统收集。纳入在急诊科停留4小时或更长时间的患者。
在6505名患者中，2757名（42.38%）直接出院，2555名（39.27%）被收治到不同病房和亚专科。此外，934名（14.35%）患者不听从医嘱自行离院，147名（2.25%）死亡，89名（1.36%）被转诊至其他医院，20名（0.30%）到达时已死亡，3名（0.04%）未看病就离开。在那些被收治的患者中，1049名（41%）患者在获得医院主要病床前停留超过10小时。大多数延误是由于获取实验室报告延迟、儿科和新生儿重症监护病房的呼吸机和 incubators 已被占用、未使用清单对患者进行适当的重新评估和早期出院、仅为雾化及静脉或肌肉注射药物而来的患者过多、收治的住院医生在将不稳定患者收治到病房前在急诊科将其留置时间过长。
该医院急诊科面临严重的过度拥挤，这使高效的标准护理不堪重负。
