Department of Emergency Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Gyeongsangnam-Do, Republic of Korea.
Department of Emergency Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Gyeongsangnam-Do, Republic of Korea.
Am J Emerg Med. 2018 Apr;36(4):620-624. doi: 10.1016/j.ajem.2017.09.041. Epub 2017 Sep 28.
Although consultations are essential for delivering safe, high-quality care to patients in emergency departments, they contribute to emergency department patient flow problems and overcrowding which is associated with several adverse outcomes, such as increases in patient mortality and poor quality care. This study aimed to investigate how time flow metrics including emergency department length of stay is influenced by changes to the internal medicine consultation policy.
This study is a pre- and post-controlled interventional study. We attempted to improve the internal medicine consultation process to be more concise. After the intervention, only attending emergency physicians consult internal medicine chief residents, clinical fellows, or junior staff of each internal medicine subspecialty who were on duty when patients required special care or an admission to internal medicine.
Emergency department length of stay of patients admitted to the department of internal medicine prior to and after the intervention decreased from 996.94min to 706.62min. The times from consultation order to admission order and admission order to emergency department departure prior to and after the intervention were decreased from 359.59min to 180.38min and from 481.89min to 362.37min, respectively. The inpatient mortality rates and Inpatient bed occupancy rates prior to and after the intervention were similar.
The improvements in the internal medicine consultation process affected the flow time metrics. Therefore, more comprehensive and cooperative strategies need to be developed to reduce the time cycle metrics and overcrowding of all patients in the emergency department.
尽管咨询对于向急诊科患者提供安全、高质量的护理至关重要，但它们会导致急诊科患者流量问题和过度拥挤，这与许多不良后果相关，例如患者死亡率增加和护理质量下降。本研究旨在调查包括急诊科停留时间在内的时间流程指标如何受到内科咨询政策变化的影响。
本研究是一项前后对照的干预性研究。我们试图改进内科咨询流程，使其更加简洁。干预后，只有主治急诊医师会咨询内科住院医师、临床研究员或值班的内科各亚专科的初级医务人员，当患者需要特殊护理或需要内科住院时。
内科住院患者的急诊科停留时间在干预前后从 996.94 分钟减少到 706.62 分钟。咨询医嘱到入院医嘱和入院医嘱到急诊科离开医嘱的时间在干预前后从 359.59 分钟减少到 180.38 分钟和从 481.89 分钟减少到 362.37 分钟。干预前后的住院患者死亡率和住院床位占用率相似。
内科咨询流程的改进影响了流量时间指标。因此，需要制定更全面和协作的策略，以减少所有急诊科患者的时间周期指标和过度拥挤问题。
