Jones Peter, Athaullah Waheedah, Harper Alana, Wells Susan, LeFevre James, Stewart Joanna, Curtis Elana, Reid Papaarangi, Ameratunga Shanthi
Adult Emergency Department, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand; Department of Surgery, University of Auckland, Auckland, New Zealand.
Adult Emergency Department, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand.
Injury. 2018 Sep;49(9):1680-1686. doi: 10.1016/j.injury.2018.05.011. Epub 2018 May 21.
A national health target for length of stay in emergency departments (ED) was introduced in 2009 to reduce crowding and improve quality of care. We aimed to determine whether the target was associated with changes in time to CT and appropriateness of CT imaging, as markers of care quality for suspected acute traumatic brain injury (TBI). We undertook a retrospective review of the case records of a random sample of people aged ≥15 years presenting to the ED with TBI from 2006 to 2013. General linear models were used to investigate changes in outcomes along with routine process times before and after the introduction of the target. Among 501 eligible cases the median (IQR) time to CT was 136 (76-247) pre target versus 119 (59-209) minutes post target, p = 0.014. The proportion of appropriate imaging was similar between periods: 77.9% (95% CI 71-83%) versus 76.6% (95%CI 72-81%), p = 0.825. Interactions suggested that the time to CT and appropriateness of imaging before and after the introduction of the target varied by ethnicity, although the changes were not clinically important. Time to assessment and length of stay did not change importantly. We found no evidence of a clinically important change in time to CT or appropriateness of imaging for suspected TBI in association with the introduction of the SSED time target. Additional research with larger cohorts of Māori and Pacific participants is recommended to understand our observed patterns by ethnicity.
2009年出台了一项关于急诊科（ED）住院时间的全国性健康目标，以减少拥挤现象并提高护理质量。我们旨在确定该目标是否与CT检查时间的变化以及CT成像的适宜性相关，以此作为疑似急性创伤性脑损伤（TBI）护理质量的指标。我们对2006年至2013年期间因TBI到急诊科就诊的年龄≥15岁的随机抽样人群的病例记录进行了回顾性研究。使用一般线性模型来研究目标出台前后结果的变化以及常规流程时间。在501例符合条件的病例中，目标出台前CT检查的中位（IQR）时间为136（76 - 247）分钟，目标出台后为119（59 - 209）分钟，p = 0.014。各时期适宜成像的比例相似：77.9%（95%CI 71 - 83%）对76.6%（95%CI 72 - 81%），p = 0.825。交互作用表明，目标出台前后CT检查时间和成像适宜性因种族而异，尽管这些变化在临床上并不重要。评估时间和住院时间没有明显变化。我们没有发现与引入SSED时间目标相关的疑似TBI的CT检查时间或成像适宜性有临床重要变化的证据。建议对更多毛利人和太平洋参与者进行进一步研究，以了解我们观察到的种族模式。
