Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham B15 2GW, UK.
Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham B15 2GW, UK.
Eur J Intern Med. 2023 Dec;118:89-97. doi: 10.1016/j.ejim.2023.07.038. Epub 2023 Aug 4.
Urgent and emergency care services face increasing pressure, impacting patient care. We evaluated the performance of acute medicine services, assessing clinical quality indicators for unplanned medical admissions to acute hospital services. 152 acute UK hospital services accepting unplanned admissions to acute and general internal medicine completed a day-of-care survey incorporating organisational structure questionnaire and patient-level data over a pre-defined 24-hour period in June 2022. Clinical quality indicators were: Early Warning Score (EWS) measurement within 30 min of hospital arrival; clinician assessment within 4 h; assessment by consultant physician within 6 h (daytime) or 14 h (night-time). Results were compared with 2019, 2020, 2021. 7293 sequential patients were included (and compared with 19,817 patients across 2019-2021). In 2022, 69% of patients (95%CI 67.7-69.9%) had an EWS documented within 30 min. 79% of patients (95%CI 77.8-79.7%) were reviewed by a clinical decision maker within 4 h of hospital arrival. Patients assessed in Same Day Emergency Care services were more likely to meet this target than those assessed in Acute Medical Units or Emergency Departments (OR 2.4, 95%CI 2.02-2.87, p<0.001). Overall, 50% of patients received consultant physician review within the target time (3065/6161, 95%CI 48.5-51.0%); performance varied with time of arrival and location of initial assessment. Performance against all three clinical quality indicators was lower than 2019, 2020 and 2021 (p<0.001 for all). Performance against all quality indicators within acute medicine services is deteriorating. However, performance in Same Day Emergency Care Units is greater than in Acute Medical Units or Emergency Departments.
紧急和急救护理服务面临越来越大的压力，影响患者护理。我们评估了急症医学服务的表现，评估了计划外医疗入院到急症医院服务的临床质量指标。2022 年 6 月，152 家接受急症和普通内科计划外入院的英国急症医院服务在预先定义的 24 小时内完成了当日护理调查，其中包括组织结构问卷和患者水平数据。临床质量指标为：医院到达后 30 分钟内进行早期预警评分（EWS）测量；临床医生在 4 小时内评估；主治医生在白天 6 小时内或夜间 14 小时内评估。结果与 2019 年、2020 年、2021 年进行了比较。共纳入 7293 例连续患者（与 2019-2021 年的 19817 例患者进行比较）。2022 年，69%的患者（95%CI 67.7-69.9%）在 30 分钟内记录了 EWS。79%的患者（95%CI 77.8-79.7%）在医院到达后 4 小时内由临床决策者进行了评估。在当天的急诊护理服务中评估的患者比在急性医疗单位或急诊部门评估的患者更有可能达到这一目标（OR 2.4，95%CI 2.02-2.87，p<0.001）。总体而言，50%的患者在目标时间内接受了主治医生的检查（3065/6161，95%CI 48.5-51.0%）；绩效随到达时间和初始评估地点而变化。所有三项临床质量指标的表现均低于 2019 年、2020 年和 2021 年（所有指标均<0.001）。急症医学服务中所有质量指标的表现都在恶化。然而，在当天的急诊护理单位的表现要好于急性医疗单位或急诊部门。
