Alawi Seyed Arash, Werner Dennis, Könneker Sören, Achenbach Johannes, Vogt Peter M, Jokuszies Andreas
Medizinische Hochschule Hannover, Klinik für Plastische, Ästhetische, Hand- und Wiederherstellungschirurgie, Replantationszentrum Niedersachsen, Schwerbrandverletztenzentrum Niedersachsen.
Medizinische Hochschule Hannover, Klinik für Anästhesiologie und Intensivmedizin.
Handchir Mikrochir Plast Chir. 2018 Aug;50(4):241-247. doi: 10.1055/a-0577-3573. Epub 2018 Aug 21.
Interdisciplinary emergency departments in Germany are seeing an increasing inflow of patients for several reasons. Since the number of patients in the emergency room cannot be planned, there may be a lack of capacity with prolonged waiting periods and delays. In particular, a significant amount of capacities is consumed by hand injuries. Also it is suspected for the discipline of plastic surgery that the majority of emergency presentations are unjustified. We provide a collection of data followed by an analysis of emergencies to better understand the increased number of patients with the aim of identifying possible solutions for the relief of emergency care.
We performed a retrospective analysis of documented patient cases seen in the interdisciplinary emergency room of the Department of Plastic, Aesthetic, Hand and Reconstructive Surgery of a university hospital. Over the span of one year, we evaluated the diagnosis, waiting time and distribution of patients over 24 hours at 7 weekdays. Furthermore, we evaluated the justification of emergency presentation and the necessity of inpatient admission.
We assessed a total of 2768 patients with an average age of 40 years (median = 37 years, male 59 %/ female 41 %) within one year (2016-2017). Of 2450 patients, 69 % were legitimate emergencies, defined by severity of trauma or disease. Proportionally, the most common cause of presentation for 2768 cases was upper extremity injury with cut and saw injuries amounting to 25 % (n = 697), followed by lacerations/bite injuries with 22 % (n = 611) and burns with 17 % (n = 477). Most services were performed between 09:00 a.m. and 01:00 p.m. There were no significant differences regarding the distribution over different weekdays. In 24 % (n = 583) of these cases, the patient was hospitalised for inpatient treatment. In 45 % of cases, there was no indication for hospitalisation after treatment. The waiting time for 2450 patients averaged 2:23 h (median = 01:43 h) until treatment.
In face of these results it may be argued, that a majority of emergency cases could be selected through filter structures to be distributed to suitable facilities. This could cover a large proportion of the 45 % legitimate, but ambulatory emergencies. Furthermore a concentration of emergency departments should take place with a simultaneous supply of financial resources to expanding emergency departments with high patient flow.
由于多种原因，德国的跨学科急诊科接待的患者数量日益增加。由于急诊室的患者数量无法提前规划，可能会出现容量不足、等待时间延长和延误的情况。特别是手部损伤消耗了大量的医疗资源。此外，整形外科怀疑大多数急诊就诊是不合理的。我们收集了一系列数据，随后对急诊情况进行分析，以便更好地了解患者数量增加的情况，目的是确定缓解急诊护理压力的可能解决方案。
我们对某大学医院整形、美容、手部及重建外科跨学科急诊室记录的患者病例进行了回顾性分析。在一年的时间里，我们评估了7个工作日内患者的诊断、等待时间以及24小时内的分布情况。此外，我们还评估了急诊就诊的合理性以及住院治疗的必要性。
我们在一年（2016 - 2017年）内共评估了2768例患者，平均年龄为40岁（中位数 = 37岁，男性占59%/女性占41%）。在2450例患者中，69%属于合理急诊，根据创伤或疾病的严重程度来定义。按比例计算，2768例病例中最常见的就诊原因是上肢切割伤和锯伤，占25%（n = 697），其次是撕裂伤/咬伤，占22%（n = 611），烧伤占17%（n = 477）。大多数服务在上午9点至下午1点之间进行。不同工作日的分布没有显著差异。在这些病例中，24%（n = 583）的患者住院接受治疗。在45%的病例中，治疗后没有住院的指征。2450例患者的平均等待时间为2小时23分钟（中位数 = 1小时43分钟），直到接受治疗。
面对这些结果，可以认为，大多数急诊病例可以通过筛选结构进行筛选，以便分配到合适的医疗机构。这可以涵盖45%合理但可门诊治疗的急诊病例中的很大一部分。此外，急诊科应集中设置，同时提供资金资源，以扩大患者流量大的急诊科。
