修订分诊对改善传统快速通道患者数量有限的急诊科就诊量的影响。

Impact of revised triage to improve throughput in an ED with limited traditional fast track population.

作者信息

Gardner Ryan M, Friedman Nathan A, Carlson Michael, Bradham Tamala S, Barrett Tyler W

机构信息

Vanderbilt University School of Medicine, Nashville, TN, United States; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.

Vanderbilt University School of Medicine, Nashville, TN, United States; Department of Emergency Medicine, UCLA Medical Center, Los Angeles, CA, United States.

出版信息

Am J Emerg Med. 2018 Jan;36(1):124-127. doi: 10.1016/j.ajem.2017.10.016. Epub 2017 Oct 7.

DOI:10.1016/j.ajem.2017.10.016

PMID:29079371

Abstract

BACKGROUND

Emergency department (ED) crowding is associated with patient safety concerns, increased patients left without being seen (LWBS), low patient satisfaction, and lost ED revenue. The objective was to measure the impact of a revised triage process on ED throughput.

METHODS

This study took place at an urban, university-affiliated, adult ED with an annual census of 70,000 and admission rate of 34%. The revised triage approach included: identifying eligible patients at triage based on complaint, comorbidities, and illness acuity; and reallocating a nurse practitioner (NP) into our triage area. We trialed the intervention from 1100-2300 on weekdays from January 13-26, 2016. Adult patients who were not likely to require intensive evaluations were eligible. Primary outcomes were throughput measures including: time to provider, ED length of stay (LOS), and LWBS. Pre- and post-intervention metrics were compared using the Mann-Whitney U test, given the non-normal distribution of the metrics.

RESULTS

The NP evaluated 120 patients of which 101 (84%) were discharged, 3 (2.5%) admitted, and 16 (13%) required more intense evaluation. Time to provider decreased from a median (IQR) of 42 (16, 114) to 27 (12.4, 81.5) minutes (p<0.01) and ED LOS from 290 (194.8, 405.6) to 257 (171.2, 363.4) minutes (p<0.01) for all patients not admitted and not requiring a consult. LWBS decreased from a pre-trial 4.6% to 2.2% (p<0.01).

CONCLUSION

The revised triage intervention was associated with improvements in several ED throughput metrics and a reduction in LWBS.

摘要

背景

急诊科拥挤与患者安全问题、未就诊离开（LWBS）患者增加、患者满意度低以及急诊科收入损失相关。目的是评估修订后的分诊流程对急诊科工作效率的影响。

方法

本研究在一所城市大学附属医院的成人急诊科进行，年接诊量为70000人次，住院率为34%。修订后的分诊方法包括：在分诊时根据患者的主诉、合并症和疾病严重程度确定 eligible 患者；并将一名执业护士（NP）重新分配到我们的分诊区域。我们于2016年1月13日至26日的工作日11:00至23:00对该干预措施进行了试验。不太可能需要 intensive 评估的成年患者 eligible。主要结局是工作效率指标，包括：见到医护人员的时间、急诊科住院时间（LOS）和LWBS。鉴于指标的非正态分布，使用曼-惠特尼U检验比较干预前后的指标。

结果

NP评估了120名患者，其中101名（84%）出院，3名（2.5%）住院，16名（13%）需要更 intensive 的评估。对于所有未住院且不需要会诊的患者，见到医护人员的时间从中位数（IQR）42（16，114）分钟降至27（12.4，81.5）分钟（p<0.01），急诊科住院时间从290（194.8，405.6）分钟降至257（171.2，363.4）分钟（p<0.01）。LWBS从试验前的4.6%降至2.2%（p<0.01）。