Duke University School of Medicine, Department of Emergency Medicine, Durham, North Carolina.
Duke University School of Medicine, Department of Biostatistics and Bioinformatics, Durham, North Carolina.
West J Emerg Med. 2020 Aug 21;21(5):1147-1155. doi: 10.5811/westjem.2020.6.44086.
Triage functions to quickly prioritize care and sort patients by anticipated resource needs. Despite widespread use of the Emergency Severity Index (ESI), there is still no universal standard for emergency department (ED) triage. Thus, it can be difficult to objectively assess national trends in ED acuity and resource requirements. We sought to derive an ESI from National Hospital Ambulatory Medical Care Survey (NHAMCS) survey items (NHAMCS-ESI) and to assess the performance of this index with respect to stratifying outcomes, including hospital admission, waiting times, and ED length of stay (LOS).
We used data from the 2010-2015 NHAMCS, to create a measure of ED visit complexity based on variables within NHAMCS. We used NHAMCS data on chief complaint, vitals, resources used, interventions, and pain level to group ED visits into five levels of acuity using a stepwise algorithm that mirrored ESI. In addition, we examined associations of NHAMCS-ESI with typical indicators of acuity such as waiting time, LOS, and disposition. The NHAMCS-ESI categorization was also compared against the "immediacy" variable across all of these outcomes. Visit counts used weighted scores to estimate national levels of ED visits.
The NHAMCS ED visits represent an estimated 805,726,000 ED visits over this time period. NHAMCS-ESI categorized visits somewhat evenly, with most visits (42.5%) categorized as a level 3. The categorization pattern is distinct from that of the "immediacy" variable within NHAMCS. Of admitted patients, 89% were categorized as NHAMCS-ESI level 2-3. Median ED waiting times increased as NHAMCS-ESI levels decreased in acuity (from approximately 14 minutes to 25 minutes). Median LOS decreased as NHAMCS-ESI decreased from almost 200 minutes for level 1 patients to nearly 80 minutes for level 5 patients.
We derived an objective tool to measure an ED visit's complexity and resource use. This tool can be validated and used to compare complexity of ED visits across hospitals and regions, and over time.
分诊的作用是快速确定治疗优先级，并根据预期的资源需求对患者进行分类。尽管广泛使用了紧急严重指数（ESI），但急诊分诊仍然没有通用的标准。因此，很难客观评估全国急诊科室的严重程度和资源需求趋势。我们试图从国家医院门诊医疗调查（NHAMCS）调查项目中得出一个 ESI（NHAMCS-ESI），并评估该指数在分层结果方面的表现，包括住院、等待时间和急诊科室留观时间（LOS）。
我们使用了 2010 年至 2015 年 NHAMCS 的数据，根据 NHAMCS 中的变量创建了一个衡量急诊就诊复杂性的指标。我们使用 NHAMCS 中关于主诉、生命体征、使用的资源、干预措施和疼痛程度的数据，通过一个类似于 ESI 的逐步算法，将急诊就诊分为五个严重程度级别。此外，我们还检查了 NHAMCS-ESI 与典型的严重程度指标（如等待时间、LOS 和处置）之间的关联。NHAMCS-ESI 分类还与所有这些结果的“紧急程度”变量进行了比较。就诊次数使用加权得分来估计全国范围内的急诊就诊次数。
在这段时间内，NHAMCS 急诊科室的就诊量估计为 805726000 次。NHAMCS-ESI 对就诊进行了相对均匀的分类，大多数就诊（42.5%）被归类为 3 级。这种分类模式与 NHAMCS 中的“紧急程度”变量明显不同。在入院患者中，89%的患者被归类为 NHAMCS-ESI 2-3 级。随着 NHAMCS-ESI 严重程度的降低，ED 等待时间中位数增加（从大约 14 分钟增加到 25 分钟）。随着 NHAMCS-ESI 从 1 级患者的近 200 分钟降至 5 级患者的近 80 分钟，LOS 中位数下降。
我们得出了一个衡量急诊就诊复杂性和资源利用的客观工具。这个工具可以被验证并用于比较医院和地区之间以及随时间变化的急诊就诊的复杂性。
