Wickman Linnéa, Svensson Per, Djärv Therese
Functional Area of Emergency Medicine, Karolinska University Hospital Solna Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Medicine (Baltimore). 2017 Nov;96(44):e8457. doi: 10.1097/MD.0000000000008457.
Crowding in emergency departments (EDs) is associated with long lengths of stay (LOS); however, it is not known whether the effect is equal across different chief complaints.The aim of the study was to compare the effect of crowding on LOS in the 10 most common medical or surgical chief complaints in the ED.All adult visits to a university hospital ED on weekdays between 8 AM and 9 PM in 2012 (n = 19,200) were stratified based on chief complaint and triage priority. The ED bed occupancy rate was measured and crowding was defined as an occupancy rate over one. The impact of crowding on LOS was calculated for the different groups.During crowding, LOS was longer among all chief complaints (P ≤.01) (except for high-acuity patients with wounds, where the study group was very small). During crowding, LOS increased the most among patients with extremity pain/swelling (145% among high-acuity patients, 125% among low-acuity patients) and flank pain (87% among high-acuity patients, 117% among low-acuity patients) and the least among patients with chest pain (32% among high-acuity patients, 45% among low-acuity patients) or arrhythmia (37% among high-acuity patients, 52% among low-acuity patients).The effect of ED crowding on LOS is unequal across different chief complaints. These findings could be used to improve the processing of specific chief complaints in the ED.
急诊科拥挤与住院时间长相关；然而，尚不清楚不同主要诉求的影响是否相同。本研究的目的是比较拥挤对急诊科10种最常见内科或外科主要诉求住院时间的影响。2012年工作日上午8点至晚上9点期间，所有到某大学医院急诊科就诊的成年患者（n = 19200）根据主要诉求和分诊优先级进行分层。测量急诊科床位占用率，将拥挤定义为占用率超过1。计算不同组中拥挤对住院时间的影响。在拥挤期间，所有主要诉求患者的住院时间都更长（P≤0.01）（伤口高 acuity 患者除外，该研究组非常小）。在拥挤期间，肢体疼痛/肿胀患者（高 acuity 患者中增加145%，低 acuity 患者中增加125%）和胁腹疼痛患者（高 acuity 患者中增加87%，低 acuity 患者中增加117%）的住院时间增加最多，而胸痛患者（高 acuity 患者中增加32%，低 acuity 患者中增加%）或心律失常患者（高 acuity 患者中增加37%，低 acuity 患者中增加52%）的住院时间增加最少。急诊科拥挤对住院时间的影响在不同主要诉求之间是不相等的。这些发现可用于改善急诊科特定主要诉求的处理。
