Computer Science and Digital Society Laboratory (LIST3N), Université de Technologie de Troyes, Troyes, France.
Public Health and Performance Department, Centre Hospitalier de Troyes, Troyes, France.
PLoS One. 2022 Jan 31;17(1):e0262914. doi: 10.1371/journal.pone.0262914. eCollection 2022.
In France, the number of emergency department (ED) admissions doubled between 1996 and 2016. To cope with the resulting crowding situation, redirecting patients to new healthcare services was considered a viable solution which would spread demand more evenly across available healthcare delivery points and render care more efficient. The objective of this study was to analyze the impact of opening new on-demand care services based on variations in patient flow at a large hospital emergency department.
We performed a before-and-after study investigating the use of unscheduled care services in the Aube region in eastern France, that focused on ED attendance at Troyes Hospital. A hierarchical clustering based on co-occurrence of diagnoses was applied which divided the population into different multimorbidity profiles. Temporal trends of the resultant clusters were also studied empirically and using regression models. A multivariate logistic regression model was constructed to adjust the periodic effect for appropriate confounders and therefore confirm its presence.
In total, 120,722 visits to the ED were recorded over a 24-month period (2018-2019) and 16 clusters were identified, accounting for 94.76% of all visits. There was a decrease of 56.77 visits per week in seven specific clusters and an increase of use of unscheduled health care services by 328.12 visits per week.
Using an innovative and reliable methodology to evaluate changes in patient flow through the ED, these findings may help inform public health policy experts on the implementation of unscheduled care services to ease pressure on hospital EDs.
在法国，1996 年至 2016 年间，急诊部（ED）入院人数翻了一番。为了应对由此产生的拥堵情况，将患者重新分配到新的医疗保健服务被认为是一种可行的解决方案，它可以更均匀地分布需求，使医疗更有效率。本研究的目的是分析在一家大型医院急诊部根据患者流量变化开设新的按需护理服务的效果。
我们进行了一项前后对照研究，调查了法国东部奥布地区非计划性护理服务的使用情况，重点是特鲁瓦医院的急诊部就诊情况。应用基于共现的诊断分层聚类，将人群分为不同的多种疾病谱。还对结果聚类的时间趋势进行了实证和回归模型研究。构建了一个多变量逻辑回归模型，以调整周期性影响的适当混杂因素，从而确认其存在。
在 24 个月（2018-2019 年）期间，共记录了 120722 次 ED 就诊，共确定了 16 个聚类，占所有就诊的 94.76%。有七个特定聚类每周减少 56.77 次就诊，每周非计划性卫生保健服务的使用增加了 328.12 次。
通过使用创新和可靠的方法来评估 ED 患者流量的变化，这些发现可能有助于为公共卫生政策专家提供有关实施非计划性护理服务以缓解医院 ED 压力的信息。
