自 2019 冠状病毒病大流行开始以来，急诊科的工作量、严重程度和拥挤情况。
Emergency Department Volume, Severity, and Crowding Since the Onset of the Coronavirus Disease 2019 Pandemic.
机构信息
US Acute Care Solutions, Canton, OH; Department of Emergency Medicine, Summa Health System, Akron, OH.
Heller School for Social Policy and Management, Brandeis University, Waltham, MA.
出版信息
Ann Emerg Med. 2023 Dec;82(6):650-660. doi: 10.1016/j.annemergmed.2023.07.024. Epub 2023 Aug 30.
STUDY OBJECTIVE
We describe emergency department (ED) visit volume, illness severity, and crowding metrics from the onset of the coronavirus disease 2019 (COVID-19) pandemic through mid-2022.
METHODS
We tabulated monthly data from 14 million ED visits on ED volumes and measures of illness severity and crowding from March 2020 through August 2022 compared with the same months in 2019 in 111 EDs staffed by a national ED practice group in 18 states.
RESULTS
Average monthly ED volumes fell in the early pandemic, partially recovered in 2022, but remained below 2019 levels (915 per ED in 2019 to 826.6 in 2022 for admitted patients; 3,026.9 to 2,478.5 for discharged patients). The proportion of visits assessed as critical care increased from 7.9% in 2019 to 11.0% in 2022, whereas the number of visits decreased (318,802 to 264,350). Visits billed as 99285 (the highest-acuity Evaluation and Management code for noncritical care visits) increased from 35.4% of visits in 2019 to 40.0% in 2022, whereas the number of visits decreased (1,434,454 to 952,422). Median and median of 90th percentile length of stay for admitted patients rose 32% (5.2 to 6.9 hours) and 47% (11.7 to 17.4 hours) in 2022 versus 2019. Patients leaving without treatment rose 86% (2.9% to 5.4%). For admitted psychiatric patients, the 90th percentile length of stay increased from 20 hours to more than 1 day.
CONCLUSION
ED visit volumes fell early in the pandemic and have only partly recovered. Despite lower volumes, ED crowding has increased. This issue is magnified in psychiatric patients.
研究目的
描述 2019 年冠状病毒病（COVID-19）大流行开始至 2022 年年中期间急诊科就诊量、疾病严重程度和拥挤程度的变化。
方法
我们对 2019 年同期 18 个州的 111 个由国家急诊科实践组工作人员的急诊科中，1400 万次急诊科就诊的数据进行了每月的统计，这些数据比较了 2020 年 3 月至 2022 年 8 月与 2019 年同期的急诊科就诊量和疾病严重程度及拥挤程度的指标。
结果
大流行早期，每月平均急诊科就诊量下降，2022 年部分恢复，但仍低于 2019 年的水平（收入患者 915 例/急诊科，2022 年为 826.6 例；出院患者 3026.9 例/急诊科，2022 年为 2478.5 例）。被评估为重症监护的就诊比例从 2019 年的 7.9%上升到 2022 年的 11.0%，而就诊数量减少（从 318802 例降至 264350 例）。就诊量最大的 99285 代码（非重症监护评估和管理的最高急症代码）从 2019 年的 35.4%增加到 2022 年的 40.0%，而就诊数量减少（从 1434454 例降至 952422 例）。收入患者的中位数和中位数 90%分位数的住院时间分别增加了 32%（从 5.2 小时增加到 6.9 小时）和 47%（从 11.7 小时增加到 17.4 小时），而与 2019 年相比，住院患者增加了 86%（从 2.9%增加到 5.4%）。未经治疗就出院的患者增加了 86%（从 2.9%增加到 5.4%）。对于收入的精神病患者，90%分位数的住院时间从 20 小时增加到 1 天以上。
结论
急诊科就诊量在大流行早期下降，目前仅部分恢复。尽管就诊量下降，但急诊科的拥挤程度有所增加。在精神科患者中，这个问题更加严重。
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