Hospital emergency department/observation unit, University of Leipzig Medical Center, Leipzig, Germany; Independent Department of General Practice, University of Leipzig, Division of Health Services Research, University of Leipzig Medical Center, Leipzig, Germany; Medical Controlling Unit, University of Leipzig Medical Center, Leipzig, Germany.
Dtsch Arztebl Int. 2022 Sep 23;119(38):640-646. doi: 10.3238/arztebl.m2022.0276.
Inpatient admission rates and the resources required upon admission to the hospital were studied as a function of the type of referral to the emergency department (ED) of a university hospital.
We retrospectively analyzed data concerning patients who were treated in the ED of the University of Leipzig Medical Center in 2019. The following data were recorded: process data, type of referral, hospital admission vs. discharge from the ED, and leading symptom according to classification as "trauma" or "non-trauma." For all admitted patients, the Patient Clinical Complexity Level (PCCL), length of hospital stay, and intensive care (yes/no) with or without ventilation were recorded.
Data on 34 178 patients (50.9 ± 22.2 years, 53.8% male) were analyzed; 28.8% of patients were referred because of "trauma," and the remaining 71.2% for "non trauma". The most common sources of referral were the rescue and emergency medical services (47.7%) and the patients themselves (self-referrals, 44.7%); 7.6% of the patients were referred by a resident doctor or general practitioner (physician). 62.6% were discharged from the ED after diagnosis and treatment, while 37.4% were admitted to the hospital. In comparison with self-referred patients as a baseline, the likelihood of inpatient admission was higher when the patient was referred by a physician (adjusted odds ratio [OR] 2.2), by the emergency rescue service without an emer - gency physician (OR 3.4), by an emergency physician (OR 9.3), or by the helicopter rescue service (OR 44.1). 49.1% of patients with trauma referred themselves to the ER, and 36% were referred by the emergency rescue service. Older and male patients were more likely to be admitted to the hospital, especially for non-trauma. 30.4% of the admitted patients required intensive care, and 35.5% of the patients in intensive care required ventilation.
Whether a patient is admitted to the hospital depends on the source of the referral and the leading symptom on arrival in the ED. One in every six self-referred patients is admitted to the hospital, particularly when the reason for presenting to the ER is non-traumatic and some of them go on to receive intensive care. The high percentage (around 95%) of self-referred trauma patients that are discharged from the ED presumably indicates that they were referred mainly for the exclusion of dangerous conditions, and/or that appropriate care options are lacking in the community setting.
本研究旨在探讨大学医院急诊科（ED）不同转诊类型与住院率及入院所需资源之间的关系。
我们回顾性分析了 2019 年莱比锡大学医学中心 ED 收治的患者数据。记录的数据包括：流程数据、转诊类型、ED 住院与出院、根据“创伤”或“非创伤”分类的主要症状。所有入院患者均记录患者临床复杂程度评分（PCCL）、住院时间、有无需要通气的重症监护（有/无）。
共分析了 34178 例患者（50.9±22.2 岁，53.8%为男性）的数据；28.8%的患者因“创伤”就诊，其余 71.2%因“非创伤”就诊。最常见的转诊来源是救援和急诊医疗服务（47.7%）和患者本人（自行就诊，44.7%）；7.6%的患者由住院医师或全科医生转诊（医生）。62.6%的患者在诊断和治疗后从 ED 出院，37.4%的患者住院。与以自行就诊为基线相比，由医生（调整优势比[OR]2.2）、无急诊医生的紧急救援服务（OR 3.4）、急诊医生（OR 9.3）或直升机救援服务（OR 44.1）转诊的患者住院可能性更高。49.1%的创伤患者自行到急诊科就诊，36%的患者由紧急救援服务转诊。年龄较大和男性患者更有可能住院，尤其是非创伤患者。30.4%的住院患者需要重症监护，35.5%的重症监护患者需要通气。
患者是否住院取决于转诊来源和到达 ED 时的主要症状。每 6 名自行就诊的患者中就有 1 名住院，特别是当他们到急诊科就诊的原因是非创伤性的，其中一些人需要接受重症监护。大约 95%的自行就诊的创伤患者从 ED 出院，这可能表明他们主要是为了排除危险情况而就诊，或者社区环境中缺乏适当的治疗选择。
