Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, 3-524 Edmonton Clinic Health Academy, Edmonton, Alberta, T6G 1C9, Canada.
Emergency Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, T5J 3E4, Canada.
BMC Health Serv Res. 2020 Oct 12;20(1):938. doi: 10.1186/s12913-020-05774-6.
This paper describes and compares patient flow characteristics of adult high system users (HSUs) and control groups in Alberta and Ontario emergency departments (EDs), Canada.
Annual cohorts of HSUs were created by identifying patients who made up the top 10% of ED users (by count of ED presentations) in the National Ambulatory Care Reporting System during 2011-2016. Random samples of patients not in the HSU groups were selected as controls. Presentation (e.g., acuity) and ED times (e.g., time to physician initial assessment [PIA], length of stay) data were extracted and described. The length of stay for 2015/2016 data was decomposed into stages and Cox models compared time between stages.
There were 20,343,230 and 18,222,969 ED presentations made by 7,032,655 and 1,923,462 individuals in the control and HSU groups, respectively. The Ontario groups had higher acuity than the Alberta groups: about 20% in the Ontario groups were from the emergent level whereas Alberta had 11-15%. Time to PIA was similar across provinces and groups (medians of 60 min to 67 min). Lengths of stay were longest for Ontario HSUs (median = 3 h) and shortest for Alberta HSUs (median = 2.2 h). HSUs had shorter times to PIA (hazard ratio [HR] = 1.03; 95% confidence interval [CI] 1.02,1.03), longer times from PIA to decision (HR = 0.84; 95%CI 0.84,0.84), and longer times from decision to leaving the ED (HR = 0.91; 95%CI 0.91,0.91).
Ontario HSUs had higher acuity and longer ED lengths of stay than the other groups. In both provinces, HSU had shorter times to PIA and longer times after assessment.
本文描述并比较了加拿大艾伯塔省和安大略省急诊部（ED）中成人高系统使用者（HSU）和对照组患者的流动特征。
通过识别 2011-2016 年国家门诊护理报告系统中 ED 就诊次数最多的前 10%患者（按 ED 就诊次数计算），创建了 HSU 的年度队列。选择 HSU 组以外的随机患者样本作为对照组。提取并描述了就诊（如急症程度）和 ED 时间（如医生初始评估[PIA]时间、住院时间）数据。对 2015/2016 年数据的住院时间进行了阶段分解，并通过 Cox 模型比较了各阶段之间的时间。
在对照组和 HSU 组中，分别有 20,343,230 和 18,222,969 人次的 ED 就诊，分别涉及 7,032,655 和 1,923,462 人。安大略省的就诊患者病情比艾伯塔省更严重：安大略省约有 20%的患者属于紧急级别，而艾伯塔省为 11-15%。PIA 时间在各省和组之间相似（中位数为 60-67 分钟）。住院时间最长的是安大略省 HSU（中位数为 3 小时），最短的是艾伯塔省 HSU（中位数为 2.2 小时）。HSU 患者的 PIA 时间更短（危险比[HR]为 1.03；95%置信区间[CI]为 1.02,1.03），PIA 到决策的时间更长（HR 为 0.84；95%CI 为 0.84,0.84），从决策到离开 ED 的时间更长（HR 为 0.91；95%CI 为 0.91,0.91）。
安大略省 HSU 的急症程度和 ED 住院时间长于其他组。在这两个省，HSU 的 PIA 时间更短，评估后时间更长。
