Irish National Audit of Stroke, National Office of Clinical Audit, St Stephen's Green, Dublin 2, Ireland.
Dept of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland.
BMC Health Serv Res. 2024 Sep 16;24(1):1075. doi: 10.1186/s12913-024-11566-z.
Hospital overcrowding where patient admissions exceed capacity is associated with worse outcomes in Emergency Department. Developments in emergency stroke care have been associated with improvements in stroke outcome but are dependent on effective, organised care. We examined if overcrowding in the hospital system was associated with negative changes in stroke outcome.
Data on overcrowding were obtained from the Irish Nurses and Midwives Organisation (INMO) 'Trolley Count' database recording the number of patients cared for on trolleys/chairs in all acute hospitals each midnight. These were compared with quarterly data from the Irish National Audit of Stroke from 2013 to 2021 inclusive. Variables analysed were inpatient mortality rate, thrombolysis rate for ischaemic stroke, median door to needle time and median length of stay.
579449 patient episodes were recorded by Trolley Watch over the period, (Quarterly Median 16719.5, range 3389-27015). Average Quarterly Thrombolysis rate was 11.3% (sd 1.3%) Median Quarterly Inpatient Mortality rate was 11.8% (Range 8.9-14.0%). Median Quarterly Length of stay was 9 days (8-11 days). Median quarterly door to needle was 65 min (45-80 min). Q1 was typically the worst for overcrowding with on average 19777 incidences (sd 4786). This was significantly higher than for Q2 (mean 13540 (sd 4785) p = 0.005 t-test) and for Q3 (mean 14542 (sd 4753) p = 0.03). No significant correlation was found between quarterly Trolley watch episodes and inpatient mortality (r = 0.084, p = 0.63), median length of stay r=-0.15, p = 0.37) or thrombolysis rate (r = 0.089 p = 0.61). There was an unexpected significant negative correlation between trolley watch data and median door to needle time (r=-0.36, p = 0.03).
Despite increasing hospital overcrowding, stroke services still managed to preserve standard of care. We could find no association between levels of overcrowding and deterioration in selected indices of patient care.
患者入院量超过医院容纳能力导致的医院人满为患与急诊科的不良结局相关。急诊卒中护理的发展与卒中结局的改善相关，但这依赖于有效和有组织的护理。我们检测了医院系统的人满为患是否与卒中结局的负面变化有关。
从爱尔兰护士和助产士组织（INMO）的“推车计数”数据库中获取了关于拥挤的数据，该数据库记录了每个午夜所有急症医院中在推车上/椅子上接受治疗的患者数量。这些数据与 2013 年至 2021 年期间的爱尔兰国家卒中审计的季度数据进行了比较。分析的变量包括住院患者死亡率、缺血性卒中溶栓率、门到针中位数和住院中位数。
在研究期间，通过推车观察共记录了 579449 例患者病例（季度中位数为 16719.5，范围为 3389-27015）。平均季度溶栓率为 11.3%（标准差 1.3%），季度中位数住院死亡率为 11.8%（范围为 8.9-14.0%）。中位数季度住院时间为 9 天（8-11 天）。中位数季度门到针中位数为 65 分钟（45-80 分钟）。第一季度通常是拥挤程度最严重的，平均有 19777 例（标准差 4786）。这显著高于第二季度（平均 13540，标准差 4785，p=0.005，t 检验）和第三季度（平均 14542，标准差 4753，p=0.03）。季度推车观察病例与住院患者死亡率（r=0.084，p=0.63）、中位数住院时间 r=-0.15，p=0.37）或溶栓率（r=0.089，p=0.61）之间未发现显著相关性。推车观察数据与中位数门到针时间之间存在意外的显著负相关（r=-0.36，p=0.03）。
尽管医院拥挤程度不断增加，但卒中服务仍设法保持了护理标准。我们没有发现拥挤程度与患者护理的选定指标恶化之间存在关联。
