Nasr Isfahani Mehdi, Davari Fereshte, Azizkhani Reza, Rezvani Majid
Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Int J Prev Med. 2020 Feb 17;11:13. doi: 10.4103/ijpvm.IJPVM_582_18. eCollection 2020.
In the past decade, factors such as population growth, increased environmental incidents, and substance abuse have caused patient-overcrowding in emergency departments (EDs). Our main objective was to assess the effects of a discharge lounge on decreasing the patient waiting time and ED overcrowding by computer simulation.
In this cross-sectional retrospective study, the statistical population consisted of 39264 persons referred to the ED of Al-Zahra Hospital. The sample size was calculated as 1275 through systematic random sampling at 99% confidence. To increase research accuracy, the number of patients was increased to 2515. Data were collected by standardized checklists and hospital information systems.
Mean waiting time for level 2 patients who left the ED against medical advice after completing the treatment was declined from 56 min to 44 min and before completing the treatment process from 80 min to 50 min. Average waiting time for level 3 patients for personal satisfaction after completing the treatment process decreased from 15 min to 13 min and before the completion of the treatment process from 67 min to 41 min; the number of discharged patients awaiting discharge was decreased at level 2 from 3 to 2 and at level 3 from 2 to 1. The number of patients waiting for admission at triage stations reduced from 44 to 39%, and the average number of patients discharged from emergency room was increased from 7 to 12.
ED overcrowding is the hallmark of a mismatch between the availability of health care resources and patient demand for emergency care. Among major factors contributing to these situations are hindrances in patient flow and occupation of ED beds by nonurgent patients. The establishment of a discharge unit in the ED could be a practical solution to ED overcrowding.
在过去十年中，人口增长、环境事故增加和药物滥用等因素导致急诊科患者过度拥挤。我们的主要目标是通过计算机模拟评估出院休息室对减少患者等待时间和急诊科过度拥挤的影响。
在这项横断面回顾性研究中，统计人群包括转诊至阿尔-扎赫拉医院急诊科的39264人。通过系统随机抽样，在99%的置信度下计算样本量为1275。为提高研究准确性，将患者数量增加到2515。数据通过标准化检查表和医院信息系统收集。
2级患者在完成治疗后违反医嘱离开急诊科的平均等待时间从56分钟降至44分钟，在完成治疗过程前从80分钟降至50分钟。3级患者完成治疗过程后为获得个人满意度的平均等待时间从15分钟降至13分钟，在完成治疗过程前从67分钟降至41分钟；2级等待出院的患者数量从3人降至2人，3级从2人降至1人。分诊站等待入院的患者数量从44%降至39%，急诊室出院的患者平均数量从7人增加到12人。
急诊科过度拥挤是医疗资源可用性与患者对急诊护理需求不匹配的标志。导致这些情况的主要因素包括患者流动受阻和非紧急患者占用急诊科床位。在急诊科设立出院单元可能是解决急诊科过度拥挤的一个切实可行的办法。
