NIHR CLAHRC Wessex, University of Southampton, Southampton, UK.
Wessex AHSN CIS, University of Southampton, Southampton, UK.
BMJ Open. 2018 May 24;8(5):e020296. doi: 10.1136/bmjopen-2017-020296.
To quantify the effect of intrahospital patient flow on emergency department (ED) performance targets and indicate if the expectations set by the National Health Service (NHS) England 5-year forward review are realistic in returning emergency services to previous performance levels.
Linear regression analysis of routinely reported trust activity and performance data using a series of cross-sectional studies.
NHS trusts in England submitting routine nationally reported measures to NHS England.
142 acute non-specialist trusts operating in England between 2012 and 2016.
The primary outcome measures were proportion of 4-hour waiting time breaches and cancelled elective operations.
Univariate and multivariate linear regression models were used to show relationships between the outcome measures and various measures of trust activity including empty day beds, empty night beds, day bed to night bed ratio, ED conversion ratio and delayed transfers of care.
Univariate regression results using the outcome of 4-hour breaches showed clear relationships with empty night beds and ED conversion ratio between 2012 and 2016. The day bed to night bed ratio showed an increasing ability to explain variation in performance between 2015 and 2016. Delayed transfers of care showed little evidence of an association. Multivariate model results indicated that the ability of patient flow variables to explain 4-hour target performance had reduced between 2012 and 2016 (19% to 12%), and had increased in explaining cancelled elective operations (7% to 17%).
The flow of patients through trusts is shown to influence ED performance; however, performance has become less explainable by intratrust patient flow between 2012 and 2016. Some commonly stated explanatory factors such as delayed transfers of care showed limited evidence of being related. The results indicate some of the measures proposed by NHS England to reduce pressure on EDs may not have the desired impact on returning services to previous performance levels.
量化医院内患者流动对急诊部门（ED）绩效指标的影响，并表明英国国民保健制度（NHS）英格兰 5 年展望设定的期望是否现实，能否使急诊服务恢复到以前的绩效水平。
使用一系列横断面研究对常规报告的信托活动和绩效数据进行线性回归分析。
向英国国民保健制度英格兰提交常规国家报告措施的 NHS 信托。
2012 年至 2016 年期间在英格兰运营的 142 家急性非专科信托。
主要观察指标是 4 小时等待时间违规和取消择期手术的比例。
使用单变量和多变量线性回归模型来显示各观察指标与信托活动各项指标（包括空日床、空夜床、日床与夜床比、ED 转换比和延迟转介护理）之间的关系。
使用 4 小时违规结果的单变量回归结果显示，2012 年至 2016 年间，空夜床和 ED 转换比与 4 小时违规之间存在明显关系。日床与夜床比显示出在 2015 年至 2016 年间解释绩效差异的能力不断增强。延迟转介护理的相关性证据很少。多变量模型结果表明，患者流动变量解释 4 小时目标绩效的能力在 2012 年至 2016 年间有所下降（19%降至 12%），而在解释取消择期手术方面有所增加（7%增至 17%）。
患者在信托机构中的流动情况被证明会影响 ED 的绩效；然而，2012 年至 2016 年间，信托机构内部的患者流动对绩效的解释能力有所下降。一些常被提及的解释因素，如延迟转介护理，其相关性证据有限。结果表明，英国国民保健制度英格兰提出的一些旨在减轻 ED 压力的措施可能不会对恢复服务到以前的绩效水平产生预期的影响。
