Van Der Linden M Christien, Van Loon-Van Gaalen Merel, Richards John R, Van Woerden Geesje, Van Der Linden Naomi
Department of Emergency Medicine, Haaglanden Medical Center, P.O. Box 432, 2501 CK, The Hague, the Netherlands.
Department of Emergency Medicine, University of California Davis Medical Center, PSSB 2100, 2315 Stockton Boulevard, Sacramento, CA, 95817, USA.
Int J Emerg Med. 2023 Feb 15;16(1):6. doi: 10.1186/s12245-023-00479-z.
During a 6-year period, several process changes were introduced at the emergency department (ED) to decrease crowding, such as the implementation of a general practitioner cooperative (GPC) and additional medical staff during peak hours. In this study, we assessed the effects of these process changes on three crowding measures: patients' length of stay (LOS), the modified National ED OverCrowding Score (mNEDOCS), and exit block while taking into account changing external circumstances, such as the COVID-19 pandemic and centralization of acute care.
We determined time points of the various interventions and external circumstances and built an interrupted time-series (ITS) model per outcome measure. We analyzed changes in level and trend before and after the selected time points using ARIMA modeling, to account for autocorrelation in the outcome measures.
Longer patients' ED LOS was associated with more inpatient admissions and more urgent patients. The mNEDOCS decreased with the integration of the GPC and the expansion of the ED to 34 beds and increased with the closure of a neighboring ED and ICU. More exit blocks occurred when more patients with shortness of breath and more patients > 70 years of age presented to the ED. During the severe influenza wave of 2018-2019, patients' ED LOS and the number of exit blocks increased.
In the ongoing battle against ED crowding, it is pivotal to understand the effect of interventions, corrected for changing circumstances and patient and visit characteristics. In our ED, interventions which were associated with decreased crowding measures included the expansion of the ED with more beds and the integration of the GPC on the ED.
在6年期间，急诊科引入了多项流程变革以减少拥挤现象，例如实施全科医生合作计划（GPC）以及在高峰时段增加医务人员。在本研究中，我们评估了这些流程变革对三项拥挤指标的影响：患者住院时间（LOS）、改良的国家急诊科过度拥挤评分（mNEDOCS）和出口堵塞情况，同时考虑了不断变化的外部环境，如新冠疫情和急性护理的集中化。
我们确定了各种干预措施和外部环境的时间点，并针对每个结果指标建立了中断时间序列（ITS）模型。我们使用自回归积分移动平均（ARIMA）模型分析选定时间点前后水平和趋势的变化，以考虑结果指标中的自相关性。
患者在急诊科的住院时间越长，与更多的住院患者入院和更紧急的患者相关。随着GPC的整合以及急诊科扩展至34张床位，mNEDOCS降低；而随着邻近急诊科和重症监护病房的关闭，mNEDOCS升高。当有更多呼吸急促患者和更多70岁以上患者到急诊科就诊时，出口堵塞情况增多。在2018 - 2019年的严重流感季，患者在急诊科的住院时间和出口堵塞数量增加。
在持续应对急诊科拥挤的斗争中，了解干预措施的效果至关重要，同时要校正不断变化的环境以及患者和就诊特征。在我们的急诊科，与减少拥挤指标相关的干预措施包括增加床位扩展急诊科以及在急诊科整合GPC。
