Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
Emergency Department, Walsall Healthcare NHS Trust, Walsall, UK.
Emerg Med J. 2022 Mar;39(3):174-180. doi: 10.1136/emermed-2021-211229. Epub 2021 Aug 4.
We investigate whether admission from a consultant-led ED is associated with ED occupancy or crowding and inpatient (bed) occupancy.
We used general additive logistic regression to explore the relationship between the probability of an ED patient being admitted, ED crowding and inpatient occupancy levels. We adjust for patient, temporal and attendance characteristics using data from 13 English NHS Hospital Trusts in 2019. We define quintiles of occupancy in ED and for four types of inpatients: emergency, overnight elective, day case and maternity.
Compared with periods of average occupancy in ED, a patient attending during a period of very high (upper quintile) occupancy was 3.3% less likely (relative risk (RR) 0.967, 95% CI 0.958 to 0.977) to be admitted, whereas a patient arriving at a time of low ED occupancy was 3.9% more likely (RR 1.039 95% CI 1.028 to 1.050) to be admitted. When the number of overnight elective, day-case and maternity inpatients reaches the upper quintile then the probability of admission from ED rises by 1.1% (RR 1.011 95% CI 1.001 to 1.021), 3.8% (RR 1.038 95% CI 1.025 to 1.051) and 1.0% (RR 1.010 95% CI 1.001 to 1.020), respectively. Compared with periods of average emergency inpatient occupancy, a patient attending during a period of very high emergency inpatient occupancy was 1.0% less likely (RR 0.990 95% CI 0.980 to 0.999) to be admitted and a patient arriving at a time of very low emergency inpatient occupancy was 0.8% less likely (RR 0.992 95% CI 0.958 to 0.977) to be admitted.
Admission thresholds are modestly associated with ED and inpatient occupancy when these reach extreme levels. Admission thresholds are higher when the number of emergency inpatients is particularly high. This may indicate that riskier discharge decisions are taken when beds are full. Admission thresholds are also high when pressures within the hospital are particularly low, suggesting the potential to safely reduce avoidable admissions.
我们研究了由顾问主导的急诊室入院是否与急诊室占用率或拥挤程度以及住院床位占用率有关。
我们使用广义加性逻辑回归来探讨急诊患者入院概率与急诊室拥挤程度和住院床位占用水平之间的关系。我们利用 2019 年来自 13 家英国国民保健署医院信托的数据，根据患者、时间和就诊特点进行调整。我们将急诊室占用率分为五个五分位数，并对四种类型的住院患者进行了划分：急诊、过夜择期、日间手术和产科。
与急诊室平均占用率相比，在占用率非常高（上五分位数）的时期就诊的患者，其入院的可能性降低了 3.3%（相对风险（RR）0.967，95%置信区间 0.958 至 0.977），而在急诊室占用率较低的时期就诊的患者，其入院的可能性增加了 3.9%（RR 1.039，95%置信区间 1.028 至 1.050）。当过夜择期、日间手术和产科住院患者数量达到五分位数上限时，从急诊室入院的概率分别上升 1.1%（RR 1.011，95%置信区间 1.001 至 1.021）、3.8%（RR 1.038，95%置信区间 1.025 至 1.051）和 1.0%（RR 1.010，95%置信区间 1.001 至 1.020）。与平均急诊住院患者占用率相比，在占用率非常高的急诊住院患者时期就诊的患者，其入院的可能性降低了 1.0%（RR 0.990，95%置信区间 0.980 至 0.999），而在占用率极低的急诊住院患者时期就诊的患者，其入院的可能性降低了 0.8%（RR 0.992，95%置信区间 0.958 至 0.977）。
当急诊室和住院床位占用率达到极端水平时，入院门槛与这些占用率之间存在适度的关联。当急诊住院患者数量特别高时，入院门槛会更高。这可能表明当床位已满时，会做出更冒险的出院决定。当医院内部压力特别低时，入院门槛也很高，这表明有可能安全减少不必要的住院治疗。
