Anesi George L, Xiong Ruiying Aria, Delgado M Kit
Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Penn Medicine Center for Health Care Innovation, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Crit Care Explor. 2023 Aug 21;5(8):e0954. doi: 10.1097/CCE.0000000000000954. eCollection 2023 Aug.
To quantify the frequency, outside of the pandemic setting, with which individual healthcare facilities faced surge periods due to severe increases in demand for emergency department (ED) care.
Retrospective cohort study.
U.S. EDs.
All ED encounters in the all-payer, nationally representative Nationwide Emergency Department Sample from the Healthcare Cost and Utilization Project, 2006-2019.
None.
Frequency of surge periods defined as ED months in which an individual facility ED saw a greater than 50% increase in ED visits per month above facility-/calendar month-specific medians. During 2006-2019, 3,317 U.S. EDs reported 354,534,229 ED visits across 142,035 ED months. Fifty-seven thousand four hundred ninety-five ED months (40.5%) during the study period had a 0% to 50% increase in ED visits that month above facility-specific medians and 1,952 ED months (1.4%) qualified as surge periods and had a greater than 50% increase in ED visits that month above facility-specific medians. These surge months were experienced by 397 unique facility EDs (12.0%). Compared with 2006, the most proximal pre-pandemic period of 2016-2019 had a notably elevated likelihood of ED-month surge periods (odds ratios [ORs], 2.36-2.84; all < 0.0005). Compared with the calendar month of January, the winter ED months in December through March have similar likelihood of an ED-month qualifying as a surge period (ORs, 0.84-1.03; all > 0.05), while the nonwinter ED months in April through November have a lower likelihood of an ED-month qualifying as a surge period (ORs, 0.65-0.81; all < 0.05).
Understanding the frequency of surges in demand for ED care-which appear to have increased in frequency even before the COVID-19 pandemic and are concentrated in winter months-is necessary to better understand the burden of potential and realized acute surge events and to inform cost-effectiveness preparedness strategies.
量化在非疫情背景下，各个医疗机构因急诊科（ED）护理需求急剧增加而面临需求激增时期的频率。
回顾性队列研究。
美国急诊科。
来自医疗成本和利用项目2006 - 2019年全支付方、具有全国代表性的全国急诊科样本中的所有急诊科就诊病例。
无。
需求激增时期的频率定义为某个医疗机构急诊科在特定月份的急诊就诊量比该机构/日历月特定中位数增加超过50%的月份。在2006 - 2019年期间，3317家美国急诊科在142,035个急诊月份报告了354,534,229次急诊就诊。在研究期间，57,495个急诊月份（40.5%）当月急诊就诊量比机构特定中位数增加了0%至50%，1952个急诊月份（1.4%）被判定为需求激增时期，当月急诊就诊量比机构特定中位数增加超过50%。这些需求激增月份出现在397家不同的医疗机构急诊科（12.0%）。与2006年相比，2016 - 2019年这个最接近疫情前的时期，急诊月份出现需求激增时期的可能性显著升高（优势比[OR]，2.36 - 2.84；均P < 0.0005）。与1月份相比，12月至次年3月的冬季急诊月份被判定为需求激增时期的可能性相似（OR，0.84 - 1.03；均P > 0.05），而4月至11月的非冬季急诊月份被判定为需求激增时期的可能性较低（OR，0.65 - 0.81；均P < 0.05）。
了解急诊科护理需求激增的频率——即使在COVID - 19大流行之前频率似乎就已增加且集中在冬季月份——对于更好地理解潜在和已发生的急性激增事件的负担以及为成本效益准备策略提供信息是必要的。
