Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
PLoS One. 2021 Feb 17;16(2):e0247042. doi: 10.1371/journal.pone.0247042. eCollection 2021.
Overcrowding in emergency departments is a serious public health issue. Recent studies have reported that overcrowding in emergency departments affects not only the quality of emergency care but also clinical decisions about admission. However, no studies have examined the characteristics of the patient groups whose admission rate is influenced by such overcrowding. This retrospective cohort study was conducted in a single emergency department between January 1 and December 31, 2018. Patients over 19 years old were enrolled and divided into three groups according to the degree of overcrowding-high, low, and non-based on the total number of patients in the emergency department. An emergency triage tool (the Korean Triage and Acuity Scale) was used, which categorizes patients into five different levels. We analyzed whether the degree of change in the admission rate according to the extent of overcrowding differed for each triage group. There were 73,776 patients in this study. In the analysis of all patient groups, the admission rate increased as the degree of overcrowding rose (the adjusted odds ratio for admission was 1.281 (1.225-1.339) in the high overcrowding group versus the non-overcrowding group). The analysis of the patients in each triage level showed an increase in the admission rate associated with the overcrowding, which was greater in the patient groups with a lower triage level (adjusted odds ratios for admission in the high overcrowding group versus non-overcrowding group: Korean Triage and Acuity Scale level 3 = 1.215 [1.120-1.317], level 4 = 1.294 [1.211-1.382], and level 5 = 1.954 [1.614-2.365]).
急诊科过度拥挤是一个严重的公共卫生问题。最近的研究报告表明，急诊科过度拥挤不仅影响急救护理的质量，还影响入院的临床决策。然而，尚无研究探讨受这种过度拥挤影响的患者群体的特征。本回顾性队列研究于 2018 年 1 月 1 日至 12 月 31 日在一家急诊科进行。纳入年龄超过 19 岁的患者，并根据急诊科患者总数将其分为三组：高拥挤度、低拥挤度和非拥挤度。使用了一种急救分诊工具（韩国分诊和紧急程度量表），将患者分为五个不同级别。我们分析了根据拥挤程度的变化，每个分诊组的入院率变化程度是否不同。本研究共纳入 73776 例患者。在所有患者组的分析中，随着拥挤程度的增加，入院率增加（与非拥挤组相比，高拥挤组的调整后入院比值比为 1.281（1.225-1.339））。在每个分诊级别患者的分析中，与拥挤相关的入院率增加，在分诊级别较低的患者组中增加更为明显（与非拥挤组相比，高拥挤组的调整后入院比值比：韩国分诊和紧急程度量表 3 级=1.215（1.120-1.317），4 级=1.294（1.211-1.382），5 级=1.954（1.614-2.365））。
