Faculty of Business and Economics, The University of Hong Kong, Hong Kong.
Department of Management Sciences, College of Business, City University of Hong Kong, Hong Kong.
Am J Emerg Med. 2022 Jan;51:163-168. doi: 10.1016/j.ajem.2021.10.049. Epub 2021 Oct 30.
The objective of this study is to evaluate the impact of emergency department (ED) crowding levels on patient admission decisions and outcomes.
A retrospective study was performed based on 2-year electronic health record data from a tertiary care hospital ED in Alberta, Canada. Using modified Poisson regression models, we studied the association of patient admission decisions and 7-day revisit probability with ED crowding levels measured by: 1) the total number of patients waiting and in treatment (ED census), 2) the number of boarding patients (boarder census), and 3) the average physician workload, calculated by the total number of ED patients divided by the number of physicians on duty (physician workload census). The control variables included age, gender, treatment area, triage level, and chief complaint. A subgroup analysis was performed to evaluate the heterogeneous effects among patients of different acuity levels.
Our dataset included 141,035 patient visit records after cleaning from August 2013 to July 2015. The patient admission probability was positively correlated with ED census (relative risk [RR] = 1.006, 95% confidence interval [CI] = 1.005 to 1.007) and physician workload census (RR = 1.029, 95% CI = 1.027 to 1.032), but inversely correlated with boarder census (RR = 0.991, 95% CI = 0.989 to 0.993). We further found that the 7-day revisit probability of discharged patients was positively associated with boarder census (RR = 1.009, 95% CI = 1.004 to 1.014).
Patient admission probability was found to be directly associated with ED census and physician workload census, but inversely associated with the boarder census. The effects of boarder census and physician workload census were stronger for patients of triage levels 3-5. Our results suggested that (i) insufficient physician staffing may lead to unnecessary patient admissions; (ii) too many boarding patients in ED leads to an increase in unsafe discharges, and as a result, an increase in 7-day revisit probability.
本研究旨在评估急诊部（ED）拥挤程度对患者入院决策和结局的影响。
本研究基于加拿大艾伯塔省一家三级保健医院 ED 的 2 年电子健康记录数据，采用回顾性研究。我们使用改良泊松回归模型，研究了患者入院决策和 7 天复诊概率与 ED 拥挤程度之间的关系，该拥挤程度通过以下三个指标来衡量：1）等待和治疗中的患者总数（ED 统计）；2）留观患者数（留观统计）；3）医生工作量，通过 ED 患者总数除以当班医生人数计算（医生工作量统计）。控制变量包括年龄、性别、治疗区、分诊级别和主要诉求。还进行了亚组分析，以评估不同严重程度患者之间的异质效应。
在对 2013 年 8 月至 2015 年 7 月的清洁后数据集进行清理后，本研究共纳入 141035 例患者就诊记录。入院概率与 ED 统计呈正相关（相对风险 [RR] = 1.006，95%置信区间 [CI] = 1.005 至 1.007），与医生工作量统计呈正相关（RR = 1.029，95% CI = 1.027 至 1.032），但与留观统计呈负相关（RR = 0.991，95% CI = 0.989 至 0.993）。我们还发现，出院患者 7 天复诊概率与留观统计呈正相关（RR = 1.009，95% CI = 1.004 至 1.014）。
入院概率与 ED 统计和医生工作量统计直接相关，而与留观统计呈负相关。留观统计和医生工作量统计对 3-5 级分诊患者的影响更强。研究结果表明，（i）医生人手不足可能导致不必要的患者入院；（ii）ED 中有太多留观患者会导致不安全出院增加，进而导致 7 天复诊概率增加。
