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新型冠状病毒肺炎大流行对急诊科患者及急性脑血管病患者整体诊疗过程的影响

Impact of COVID-19 Pandemic on the Overall Diagnostic and Therapeutic Process for Patients of Emergency Department and Those with Acute Cerebrovascular Disease.

作者信息

Chang Hansol, Yu Jae Yong, Yoon Sun Young, Hwang Sung Yeon, Yoon Hee, Cha Won Chul, Sim Min Seob, Jo Ik Joon, Kim Taerim

机构信息

Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 115 Irwon-ro Gangnam-gu, Seoul 06355, Korea.

Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, 115 Irwon-ro Gangnam-gu, Seoul 06355, Korea.

出版信息

J Clin Med. 2020 Nov 26;9(12):3842. doi: 10.3390/jcm9123842.

Abstract

(1) Background: During a pandemic, patients and processes in the emergency department (ED) change. These circumstances affect the length of stay (LOS) or degree of crowding in the ED. The processes for patients with acute critical illness, such as cerebrovascular disease (CVD), can be also delayed. Using the process mining (PM) method, this study aimed to evaluate LOS, ED processes for CVD, and delayed processes during the coronavirus disease 2019 (COVID-19) pandemic. (2) Methods: Data were collected from the Clinical Data Warehouse of a medical center. Phase 1 included patients who visited the ED before the COVID-19 outbreak. In Phase 2, post-COVID-19 ED patients were divided into the COVID-19 tested group (CTG) and COVID-19 not tested group (CNTG) according to whether polymerase chain reaction test was performed. We analyzed patients' ED processes before and after COVID-19 using the PM method. We analyzed patients with acute CVD separately to determine whether the process and LOS of patients with acute critical illness were changed or delayed. (3) Results: After the COVID-19 outbreak, the overall LOS was delayed and all processes in CTG patients were delayed. Registration to triage and triage were delayed in both CTG and CNTG patients. The brain imaging process for CTG patients with acute CVD was also delayed. (4) Conclusion: After a pandemic, some processes were changed, new processes were developed, and processes for patients with acute CVD who needed proper time management were not exempted.

摘要

(1) 背景:在大流行期间,急诊科(ED)的患者和流程会发生变化。这些情况会影响急诊科的住院时间(LOS)或拥挤程度。急性危重病患者的流程,如脑血管疾病(CVD),也可能会延迟。本研究旨在使用流程挖掘(PM)方法评估2019冠状病毒病(COVID-19)大流行期间的住院时间、CVD患者在急诊科的流程以及延迟的流程。(2) 方法:数据从一家医疗中心的临床数据仓库收集。第一阶段包括在COVID-19疫情爆发前到急诊科就诊的患者。在第二阶段,根据是否进行了聚合酶链反应检测,将COVID-19疫情后到急诊科就诊的患者分为COVID-19检测组(CTG)和COVID-19未检测组(CNTG)。我们使用PM方法分析了COVID-19前后患者的急诊科流程。我们分别分析了急性CVD患者,以确定急性危重病患者的流程和住院时间是否发生了变化或延迟。(3) 结果:COVID-19疫情爆发后,总体住院时间延迟,CTG组患者的所有流程均延迟。CTG组和CNTG组患者从挂号到分诊以及分诊过程均延迟。CTG组急性CVD患者的脑部成像流程也延迟。(4) 结论:大流行后,一些流程发生了变化,出现了新的流程,需要适当时间管理的急性CVD患者的流程也未能幸免。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2ce6/7760535/e126170a4cff/jcm-09-03842-g001.jpg

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