急诊科危重症患者住院时间延长与院内死亡率升高相关。
Increased Length of Stay of Critically Ill Patients in the Emergency Department Associated with Higher In-hospital Mortality.
作者信息
Verma Ankur, Shishodia Shakti, Jaiswal Sanjay, Sheikh Wasil R, Haldar Meghna, Vishen Amit, Ahuja Rinkey, Khatai Abbas A, Khanna Palak
机构信息
Department of Emergency Medicine, Max Super Speciality Hospital, Delhi, India.
出版信息
Indian J Crit Care Med. 2021 Nov;25(11):1221-1225. doi: 10.5005/jp-journals-10071-24018.
OBJECTIVES
Emergency department (ED) length of stay (LOS) is defined as the time a patient is registered to the time the patient is shifted to a hospital bed or discharged. Increasing demand for quality emergency care has resulted in increased wait times due to demand and supply mismatch. It is perceived that longer LOS in the ED of critical patients leads to poor outcomes. Our goal was to study the impact of LOS in the ED on the patients who required critical care admissions.
METHODS
This was a retrospective study conducted in the ED of a tertiary center. Data were collected using electronic health records (EHR) for patients admitted to the intensive care units (ICUs). Patient's LOS in ED was divided into 0-4, 4-8, 8-12, 12-24, and >24 hours. ED LOS was calculated from the registration time to the time patient was handed over in the ICU. Patients were divided into four categories (1-4) based on their criticality. LOS in ED, mortality, and total hospital LOS were analyzed in the study.
RESULTS
Three thousand four hundred and twenty-nine patients were enrolled in the study. Mean age was 62.69 years (95% CI 62.11-63.26). A total of 42.09% (95% CI 40.5-43.8) were Category 1 patients. Overall mortality rate was 52.46% (95% CI 50.79-54.13). LOS of 48.15% (95% CI 46.54-49.88) patients in the ED was between 0 and 4 hours, 19.90% (95% CI 18.62-21.29) between 4 and 8 hours, 8.21% (95% CI 7.35-9.19) between 8 and 12 hours, 15.50% (95% CI 14.34-16.77) between 12 and 24 hours, and 8.13% (95% CI 7.27-9.10) >24 hours. Mortality for LOS of 0-4 hours was 51.30% (95% CI 48.89-53.70), 54.03% (95% CI 50.28-57.73) for 4-8 hours, 48.94% (95% CI 43.16-54.75) for 8-12 hours, 51.50% (95% CI 47.26-55.72) for 12-24 hours, and 60.57% (95% CI 54.73-66.13) for >24 hours.
CONCLUSION
We concluded that the longer the critically ill patients are boarded in the ED, the higher is the chance for mortality. Processes should be implemented to ease the throughput from the ED.
HOW TO CITE THIS ARTICLE
Verma A, Shishodia S, Jaiswal S, Sheikh WR, Haldar M, Vishen A, Increased Length of Stay of Critically Ill Patients in the Emergency Department Associated with Higher In-hospital Mortality. Indian J Crit Care Med 2021;25(11):1221-1225.
目的
急诊科（ED）住院时间（LOS）定义为患者登记时间至被转移至医院病床或出院的时间。由于供需不匹配，对优质急诊护理的需求增加导致等待时间延长。人们认为，危重症患者在急诊科住院时间延长会导致不良后果。我们的目标是研究急诊科住院时间对需要重症监护病房收治的患者的影响。
方法
这是一项在三级中心急诊科进行的回顾性研究。使用电子健康记录（EHR）收集入住重症监护病房（ICU）患者的数据。将患者在急诊科的住院时间分为0 - 4小时、4 - 8小时、8 - 12小时、12 - 24小时和>24小时。急诊科住院时间从登记时间计算至患者在ICU交接的时间。根据患者的危急程度将其分为四类（1 - 4）。在研究中分析了急诊科住院时间、死亡率和总住院时间。
结果
共有3429名患者纳入研究。平均年龄为62.69岁（95%置信区间62.11 - 63.26）。共有42.09%（95%置信区间40.5 - 43.8）为1类患者。总体死亡率为52.46%（95%置信区间50.79 - 54.13）。48.15%（95%置信区间46.54 - 49.88）的患者在急诊科的住院时间为0至4小时，19.90%（95%置信区间18.62 - 21.29）为4至8小时，8.21%（95%置信区间7.35 - 9.19）为8至12小时，15.50%（95%置信区间14.34 - 16.77）为12至24小时，8.13%（95%置信区间7.27 - 9.10）>24小时。0至4小时住院时间的死亡率为51.30%（95%置信区间48.89 - 53.70），4至8小时为54.03%（95%置信区间50.28 - 57.73），8至12小时为48.94%（95%置信区间43.16 - 54.75），12至24小时为51.50%（95%置信区间47.26 - 55.72），>24小时为60.57%（95%置信区间54.73 - 66.13）。
结论
我们得出结论，危重症患者在急诊科停留时间越长，死亡几率越高。应实施相关流程以缓解急诊科的患者流转。
如何引用本文
Verma A, Shishodia S, Jaiswal S, Sheikh WR, Haldar M, Vishen A, 《急诊科危重症患者住院时间延长与更高的院内死亡率相关》。《印度重症监护医学杂志》2021；25(11):1221 - 1225。
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