Mangino Alyssa, Balaji Lakshman, Stenson Bryan, Nathanson Larry A, Chiu David, Grossman Shamai A
Department of Emergency Medicine, Harvard Medical School Beth Israel Deaconess Medical Center Boston Boston Massachusetts USA.
J Am Coll Emerg Physicians Open. 2024 Aug 5;5(4):e13195. doi: 10.1002/emp2.13195. eCollection 2024 Aug.
During the coronavirus disease 2019 (COVID-19) pandemic surge, alternate care sites (ACS) such as the waiting room or hospital lobby were created amongst hospitals nationwide to help alleviate emergency department (ED) overflow. Despite the end of the pandemic surge, many of these ACS remain functional given the burden of prolonged ED wait times, with providers now utilizing the waiting room or ACS to initiate care. Therefore, the objective of this study is to evaluate if initiating patient care in ACS helps to decrease time to disposition.
Retrospective data were collected on 61,869 patient encounters presenting to an academic medical center ED. Patients with an emergency severity index (ESI) of 1 were excluded. The "pre-ACS" or control data consisted of 38,625 patient encounters from September 30, 2018 to October 1, 2019, prior to the development of ACS, in which the patient was seen by a physician after they were brought to an assigned ED room. The "post-ACS" study cohort consisted of 23,244 patient encounters from September 30, 2022 to October 1, 2023, after the initiation of ACS, during which patients were initially seen by a provider in an ACS. ACS at this institution included the three following areas: waiting room, ambulance waiting area, and a newly constructed ACS that was built next to the ED entrance on the first floor of the hospital. The newly constructed ACS consisted of 16 care spaces each containing an upright exam chair with dividers between each care space. Door-to-disposition time (DTD) was calculated by identifying the time when the patient entered the ED and the time when disposition was decided (admission requested or patient discharged). Using regression analysis, we compared the two data sets to determine significant differences among DTD time.
The largest proportion of encounters were among ESI 3 patients, that is, 56.1%. There was a significant increase in median DTD for ESI 2 and 3 patients who were seen initially in an ACS compared to those who were not seen until they were in an assigned ER room. Specifically, there was a median increase of 40.9 min for ESI 2 patients and 18.8 min for ESI 3 patients who were seen initially in an ACS ( < 0.001). There was a 29-min decrease in median DTD for ESI 5 patients who were seen in ACS ( = 0.09).
Initiating patient care earlier in ACS did not appear to decrease DTD time for patients in the ED. Overall, the benefits of early initiation of care likely lie elsewhere within patient care and the ED throughput process.
在2019年冠状病毒病（COVID-19）大流行高峰期，全国各地的医院设立了诸如候诊室或医院大厅等替代护理场所（ACS），以帮助缓解急诊科（ED）的拥堵。尽管大流行高峰期已经结束，但由于急诊科等待时间过长的负担，许多这些ACS仍然在发挥作用，现在医护人员利用候诊室或ACS开始提供护理。因此，本研究的目的是评估在ACS开始对患者进行护理是否有助于减少处置时间。
收集了一家学术医疗中心急诊科61869例患者就诊的回顾性数据。排除急诊严重程度指数（ESI）为1的患者。“ACS前”或对照数据包括2018年9月30日至2019年10月1日ACS设立之前的38625例患者就诊数据，在此期间，患者被带到指定的急诊室后由医生进行诊治。“ACS后”研究队列包括2022年9月30日至2023年10月1日ACS启用后的23244例患者就诊数据，在此期间，患者最初由医护人员在ACS进行诊治。该机构的ACS包括以下三个区域：候诊室、救护车等候区以及医院一楼急诊入口旁新建的一个ACS。新建的ACS有16个护理空间，每个护理空间都有一把直立式检查椅，每个护理空间之间有隔板。通过确定患者进入急诊室的时间和决定处置（请求住院或患者出院）的时间来计算从就诊到处置的时间（DTD）。使用回归分析，我们比较了这两个数据集，以确定DTD时间之间的显著差异。
就诊比例最高的是ESI 3级患者，即56.1%。与那些直到被带到指定的急诊室才接受诊治的患者相比，最初在ACS接受诊治的ESI 2级和3级患者的DTD中位数显著增加。具体而言，最初在ACS接受诊治的ESI 2级患者的DTD中位数增加了40.9分钟，ESI 3级患者增加了18.8分钟（<0.001）。在ACS接受诊治的ESI 5级患者的DTD中位数减少了29分钟（=0.09）。
在ACS更早地开始对患者进行护理似乎并没有减少急诊科患者的DTD时间。总体而言，早期开始护理的好处可能在于患者护理和急诊流程的其他方面。
