Paton Andrew, Mitra Biswadev, Considine Julie
Adult Retrieval Victoria, Melbourne, Victoria, Australia.
Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.
Emerg Med Australas. 2019 Apr;31(2):211-215. doi: 10.1111/1742-6723.13120. Epub 2018 Jun 25.
To determine the relationships between: (i) total ED length of stay (EDLOS) and in-hospital mortality, ward clinical deterioration; and (ii) between time of bed request, ward transfer and in-hospital mortality, with a particular focus on patients transferred just prior to a 4 h EDLOS.
Retrospective cohort study using data from three acute care hospitals in Melbourne, Australia. Adult patients admitted from the ED to a non-monitored ward within 8 h. Patients were sub-grouped by EDLOS; EDLOS 3.5-4 h compared to 0-3.5 h and 4-8 h. In-hospital mortality, number of medical emergency team (MET)/cardiac arrest team (CAT) events.
A total of 24 746 patients were included: 4396 patients with EDLOS <210 min; 4090 patients with EDLOS of 210-240 min; and 16 260 patients with EDLOS >240 min. Mortality overall was 2.2% (n = 545), highest mortality was seen with EDLOS >4 h (2.4%, n = 399) and lowest in patients with EDLOS 3.5-4 h (1.5%, n = 63, OR 0.67 [95% CI: 0.47-0.93, P = 0.02]). Time from bed request to transfer of >240 min was associated with increased odds of death at hospital discharge (adjusted OR 1.39 [95% CI: 1.08-1.78]). There was no difference in rate of MET calls within 24 h between groups (3.5-4 h = 64 [1.5%], <3.5 h = 60 [1.5%], 4-8 h = 235 [1.4%]).
Both shorter time in ED and shorter time between bed request and ward transfer were independently associated with improved outcomes. Whole of hospital measures to reduce length of stay in the ED should focus on shorter ward transfer times after bed request.
确定以下两者之间的关系：（i）急诊总住院时长（EDLOS）与院内死亡率、病房临床病情恶化情况；（ii）床位申请时间、转至病房时间与院内死亡率之间的关系，尤其关注在急诊住院时长达到4小时之前转至病房的患者。
采用澳大利亚墨尔本三家急性护理医院的数据进行回顾性队列研究。成年患者在8小时内从急诊转至非监护病房。患者按急诊住院时长分组；将急诊住院时长3.5 - 4小时的患者与0 - 3.5小时和4 - 8小时的患者进行比较。观察院内死亡率、医疗急救团队（MET）/心脏骤停团队（CAT）事件的发生次数。
共纳入24746例患者：急诊住院时长<210分钟的患者4396例；急诊住院时长为210 - 240分钟的患者4090例；急诊住院时长>240分钟的患者16260例。总体死亡率为2.2%（n = 545），急诊住院时长>4小时的患者死亡率最高（2.4%，n = 399），急诊住院时长3.5 - 4小时的患者死亡率最低（1.5%，n = 63，比值比0.67 [95%置信区间：0.47 - 0.93，P = 0.02]）。从床位申请到转至病房的时间>240分钟与出院时死亡几率增加相关（校正后比值比1.39 [95%置信区间：1.08 - 1.78]）。各组在24小时内医疗急救团队呼叫率无差异（3.5 - 4小时组 = 64例[1.5%]，<3.5小时组 = 60例[1.5%]，4 - 8小时组 = 235例[1.4%]）。
急诊停留时间较短以及床位申请到转至病房的时间较短均与改善预后独立相关。全院范围内减少急诊住院时长的措施应侧重于缩短床位申请后的病房转至时间。
