Emergency Department, Akershus University Hospital, Lørenskog, Norway.
Lovisenberg Diaconal University College, Oslo, Norway.
BMC Health Serv Res. 2019 Jul 22;19(1):506. doi: 10.1186/s12913-019-4342-4.
Emergency department (ED) crowding and prolonged length of stay (LOS) are associated with delays in treatment, adverse outcomes and decreased patient satisfaction. Hospital restructuring and mergers are often associated with increased ED crowding. The aim of this study was to explore ED crowding and LOS in Norway's largest ED before and after an increased catchment area.
The catchment area of Akershus University Hospital increased by approximately 150,000 inhabitants in 2011, from 340,000 to 490,000. In this retrospective study, admissions to the ED during a six-year period, from Jan 1st 2010 to Dec 31st 2015 were included and analyzed.
A total of 179,989 admissions were included (51.0% men). The highest occupancy rate was in the age group 70-79 years. Following the increase in the catchment area, the annual ED admissions increased by 8343 (40.9%) from 2010 to 2011, and peaked in 2013 (34,002). Mean LOS increased from 3:59 h in 2010 to 4:17 in 2012 (highest), and decreased to 3:45 h in 2015 after staff, capacity and organizational measures. In 2010, 37.9% of the ED patients experienced crowding, and this proportion increased to between 52.9-77.6% in 2011-2015. Crowding peaked between 4 and 5 PM.
LOS increased and crowding was more frequent after a major increase in the hospital's catchment area in Norway's largest emergency department. Even after 5 years, the LOS was higher than before the expansion, mainly because of the throughput and output components, which were not properly adapted to the changes in input.
急诊部（ED）拥挤和住院时间延长（LOS）与治疗延误、不良后果和降低患者满意度有关。医院结构调整和合并通常与 ED 拥挤增加有关。本研究的目的是在挪威最大的 ED 中探索增加服务区面积前后的 ED 拥挤和 LOS。
阿克什胡斯大学医院的服务区在 2011 年增加了约 15 万居民，从 34 万增加到 49 万。在这项回顾性研究中，纳入了 2010 年 1 月 1 日至 2015 年 12 月 31 日期间的六年 ED 入院情况，并进行了分析。
共纳入 179989 例入院（51.0%为男性）。入住率最高的是 70-79 岁年龄组。在服务区扩大后，2010 年至 2011 年 ED 年入院人数增加了 8343 人（40.9%），2013 年达到峰值（34002 人）。平均 LOS 从 2010 年的 3:59 小时增加到 2012 年的 4:17 小时（最高），并在 2015 年工作人员、容量和组织措施实施后降至 3:45 小时。2010 年，37.9%的 ED 患者存在拥挤现象，2011 年至 2015 年，这一比例增加到 52.9-77.6%。拥挤现象在下午 4 点至 5 点之间达到高峰。
在挪威最大的急诊部医院服务区大幅扩大后，LOS 增加，拥挤现象更为频繁。即使在 5 年后，LOS 仍高于扩张前，主要是因为吞吐量和输出部分没有适应输入的变化。
