不同规模分娩医院的日患者流量不均衡——610227 例分娩的 11 年登记研究。
Daily patient flow unevenness in different sized delivery hospitals - An 11-year register study of 610 227 deliveries.
机构信息
University of Helsinki, Faculty of Medicine, Doctoral Programme in Clinical Research, Haartmanninkatu 8, 00290 Helsinki, Finland.
Tampere University of Applied Sciences, Kuntokatu 3, 33520 Tampere, Finland.
出版信息
Eur J Obstet Gynecol Reprod Biol. 2021 Nov;266:187-190. doi: 10.1016/j.ejogrb.2021.09.007. Epub 2021 Sep 13.
OBJECTIVES
To describe the unevenness in daily patient flow (quiet, optimal and busy days) in different sized delivery hospitals.
STUDY DESIGN
Population based register-study of 610 227 hospital deliveries. Data were collected from the Finnish Medical Birth Register from 2006 to 2016. Delivery hospitals (N = 26) were stratified into four categories by annual delivery volume: C1 <1000, C2 1000-1999, C3 2000-2999, C4 ≥3000. Uneven daily patient flow was defined based on the mean of daily delivery volume for each hospital category: quiet day (≤50% of the mean), optimal day (>50% of the mean to <two times the mean) and busy day (≥two times the mean or more).
RESULTS
The mean of daily delivery volume varied from 2.0 to 12.6 between the smallest and the largest hospital, respectively in hospital categories C1 and C4. The daily delivery volume was optimal in 41.2%, 68.3%, 84.0%, and 91.0% of the days in hospital categories C1, C2, C3, and C4, respectively. In the smallest hospitals (C1) almost half of the days appeared to be quiet (42.9%) whereas in the larger hospitals approximately one in four (25.4%), one in seven (13.6%), and less than one in ten of the days were quiet, in the categories C2, C3, and C4 respectively. Busy days were most common in the smallest hospitals (C1) where one in six of the day (15.9%) had daily delivery volume ≥two times the mean or more. In the other hospital categories busy days were rare, and the lowest in the largest hospitals.
CONCLUSIONS
Unevenness in daily patient flow was more prominent in the smaller delivery units compared to larger ones. Quiet and busy days both caused challenges to delivery unit organisations. During quiet days, fully over-resourcing of staffing occurred whereas during busy days there was a risk of under-resourcing. It is possible to optimise the size of delivery units to minimise the variation of the daily patient flow to decrease the number of quiet and busy days.
目的
描述不同规模分娩医院日常患者流量（安静、最佳和繁忙日）的不均衡性。
研究设计
这是一项基于人群的登记研究，纳入了 610227 例医院分娩。数据来自 2006 年至 2016 年的芬兰医疗分娩登记处。根据年分娩量，将分娩医院（N=26）分为四组：C1<1000、C2 1000-1999、C3 2000-2999、C4≥3000。根据医院类别中每日分娩量的平均值，定义每日患者流量不均衡：安静日（≤平均值的 50%）、最佳日（>平均值的 50%至<平均值的 2 倍）和繁忙日（≥平均值的 2 倍或更多）。
结果
在医院类别 C1 和 C4 中，最小和最大医院的每日分娩量平均值分别为 2.0 至 12.6。医院类别 C1、C2、C3 和 C4 中，每日分娩量分别有 41.2%、68.3%、84.0%和 91.0%的天数处于最佳状态。在最小的医院（C1），近一半的天数似乎是安静的（42.9%），而在较大的医院，大约四分之一（25.4%）、七分之一（13.6%）和不到十分之一（10.4%）的天数是安静的，分别在 C2、C3 和 C4 类别中。繁忙日在最小的医院（C1）最为常见，其中六分之一（15.9%）的日子的日分娩量≥平均值的 2 倍或更多。在其他医院类别中，繁忙日很少见，在最大的医院中则最少见。
结论
与较大的分娩单位相比，较小的分娩单位的日常患者流量不均衡更为明显。安静日和繁忙日都对分娩单位的组织构成了挑战。在安静日，人员配备完全超配，而在繁忙日，则存在人员配备不足的风险。通过优化分娩单位的规模，尽可能减少每日患者流量的变化，可以减少安静日和繁忙日的数量。
Zotero 插件