Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA; Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI.
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA; Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI.
Ann Emerg Med. 2022 Feb;79(2):172-181. doi: 10.1016/j.annemergmed.2021.08.015. Epub 2021 Oct 28.
To examine whether hospital occupancy was associated with increased testing and treatment during emergency department (ED) evaluations, resulting in reduced admissions.
We analyzed the electronic health records of an urban academic ED. We linked data from all ED visits from October 1, 2010, to May 29, 2015, with daily hospital occupancy (inpatients/total staffed beds). Outcome measures included the frequency of laboratory testing, advanced imaging, medication administration, and hospitalizations. We modeled each outcome using multivariable negative binomial or logistic regression, as appropriate, and examined their association with daily hospital occupancy quartiles, controlling for patient and visit characteristics. We calculated the adjusted outcome rates and relative changes at each daily hospital occupancy quartile using marginal estimating methods.
We included 270,434 ED visits with a mean patient age of 48.1 (standard deviation 19.8) years; 40.1% were female, 22.8% were non-Hispanic Black, and 51.5% were commercially insured. Hospital occupancy was not associated with differences in laboratory testing, advanced imaging, or medication administration. Compared with the first quartile, the third and fourth quartiles of daily hospital occupancy were associated with decreases of 1.5% (95% confidence interval [CI] -2.9 to -0.2; absolute change -0.6 percentage points [95% CI -1.2 to -0.1]) and 4.6% (95% CI -6.0 to -3.2; absolute change -1.9 percentage points [95% CI -2.5 to -1.3]) in hospitalizations, respectively.
The lack of association between hospital occupancy and laboratory testing, advanced imaging, and medication administration suggest that changes in ED testing or treatment did not facilitate the decrease in admissions during periods of high hospital occupancy.
检验急诊（ED）评估期间医院入住率是否与增加的检查和治疗相关，从而降低住院率。
我们分析了一家城市学术 ED 的电子健康记录。我们将 2010 年 10 月 1 日至 2015 年 5 月 29 日所有 ED 就诊的数据与每日医院入住率（住院患者/总床位）相关联。结果测量包括实验室检查、高级影像学、药物治疗和住院的频率。我们使用多变量负二项式或逻辑回归分别对每种结果进行建模，并在控制患者和就诊特征的情况下，检验它们与每日医院入住率四分位数的关联。我们使用边缘估计方法计算了每个每日医院入住率四分位数的调整后结果率和相对变化。
我们纳入了 270434 次 ED 就诊，患者平均年龄为 48.1（标准差 19.8）岁；40.1%为女性，22.8%为非西班牙裔黑人，51.5%为商业保险。医院入住率与实验室检查、高级影像学或药物治疗无差异。与第一四分位数相比，第三和第四四分位数的每日医院入住率分别与住院率下降 1.5%（95%置信区间[CI]：-2.9 至-0.2；绝对变化：-0.6 个百分点[95% CI：-1.2 至-0.1]）和 4.6%（95% CI：-6.0 至-3.2；绝对变化：-1.9 个百分点[95% CI：-2.5 至-1.3]）相关。
医院入住率与实验室检查、高级影像学和药物治疗之间缺乏关联表明，ED 检查或治疗的变化并未在高医院入住率期间促进住院率下降。
