Oakland University William Beaumont School of Medicine, 586 Pioneer Dr, Rochester, MI 48309, United States of America.
Department of Emergency Medicine, Troy Beaumont Hospital, 44201 Dequindre Rd, Troy, MI 48085, United States of America.
Am J Emerg Med. 2018 Oct;36(10):1874-1879. doi: 10.1016/j.ajem.2018.08.021. Epub 2018 Aug 7.
Prolonged emergency department (ED) length of stay (LOS) is associated with poorer clinical outcomes and patient experience. At our community hospital, trauma patients were experiencing extended ED LOS incommensurate with their clinical status. Our objective was to determine if operational modifications to patient flow would reduce the LOS for trauma patients.
We conducted a retrospective chart review of admitted trauma patients from January 1, 2015 to June 30, 2016 to study two interventions. First, a communication intervention [INT1], which required the ED provider to directly notify the trauma service, was studied. Second, a bed intervention [INT2], which reserved two temporary beds for trauma patients, was added. The primary outcome was the average ED LOS change across three time periods: (1) Baseline data [BASE] collected from January 1, 2015 to June 30, 2015, (2) INT1 data collected from July 1, 2015 to October 18, 2015, and (3) INT2 data collected from October 19, 2015 to June 30, 2016. Data was analyzed using descriptive statistics, two-sample t-tests, and multivariate linear regression.
A total of 777 trauma patients were reviewed, with 151, 150 and 476 reviewed during BASE, INT1, and INT2 time periods, respectively. BASE LOS for trauma patients was 389 min. After INT1, LOS decreased by 74.35 min (±31.92; p < 0.0001). After INT2 was also implemented, LOS decreased by 164.56 min (±22.97; p < 0.0001) from BASE LOS.
Direct communication with the trauma service by the ED provider and reservation of two temporary beds significantly decreased the LOS for trauma patients.
急诊部（ED）停留时间（LOS）延长与较差的临床结果和患者体验有关。在我们的社区医院，创伤患者的 ED LOS 延长与其临床状况不成比例。我们的目标是确定患者流程的操作修改是否会减少创伤患者的 LOS。
我们对 2015 年 1 月 1 日至 2016 年 6 月 30 日期间收治的创伤患者进行了回顾性病历审查，以研究两种干预措施。首先，研究了一种沟通干预措施[INT1]，要求 ED 提供者直接通知创伤服务。其次，添加了床位干预措施[INT2]，为创伤患者预留了两张临时床位。主要结局是三个时间段的 ED LOS 变化平均值：（1）从 2015 年 1 月 1 日至 2015 年 6 月 30 日收集的基线数据[BASE]，（2）从 2015 年 7 月 1 日至 2015 年 10 月 18 日收集的 INT1 数据，以及（3）从 2015 年 10 月 19 日至 2016 年 6 月 30 日收集的 INT2 数据。使用描述性统计、两样本 t 检验和多元线性回归分析数据。
共审查了 777 例创伤患者，BASE、INT1 和 INT2 期间分别有 151、150 和 476 例患者。创伤患者的 BASE LOS 为 389 分钟。INT1 后， LOS 减少了 74.35 分钟（±31.92；p<0.0001）。实施 INT2 后，LOS 比 BASE LOS 减少了 164.56 分钟（±22.97；p<0.0001）。
ED 提供者与创伤服务的直接沟通以及预留两张临时床位可显著降低创伤患者的 LOS。
