de Groot Bas, Meijs Nicoline T C, Moscova Michelle, Raven Wouter, Gaakeer Menno I, Thijssen Wendy A M H, Lameijer Heleen, Shetty Amith, Lassen Annmarie T
Department of Emergency Medicine, Radboud University Medical Centre, Postbus 9101, 6500 HB, Geert Grooteplein Zuid 22, Nijmegen, the Netherlands.
Research Centre for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.
Int J Emerg Med. 2024 Sep 27;17(1):123. doi: 10.1186/s12245-024-00715-0.
A wide variation of emergency medical system configurations across countries has limited the value of comparison of quality and performance measures in the past. Furthermore, lack of quantitative data on EDs prevents definition of the problems and possibilities for data driven improvement of quality of care. Therefore, the objective is to describe and compare Emergency Department (ED) populations and characteristics, and their outcomes in the Netherlands, Denmark and Australia, using a recently developed template for uniform reporting of standardized measuring and describing of care provided in the ED (structure, staffing and governance, population, process times and outcomes).
This international multicenter cohort included all consecutive ED visits from National Quality Registries or Databases from participating sites from three countries. Patient and ED characteristics (using the template for uniform reporting) and relevant clinical outcomes were described and compared per country.
We included 212,515 ED visits in the Netherlands, 408,673 in Denmark and 556,652 in Australia. Patient characteristics differed markedly, with Australian ED patients being younger, less often triaged as "immediate", and less often triaged with the high-risk chief complaints "feeling unwell" compared to Danish and Dutch patients. ED characteristics mainly differed with respect to the mean annual census per ED (Netherlands 26,738 (SD 2630), Denmark 36,675 (SD 12974), Australia 50,712 (4884)), median (IQR) lengths of stay of patients discharged home (Netherlands 2.1 (1.4-3.1); Denmark 2.8 (1.7-5.0); Australia 3.3 (2.0-5.0) hrs) and proportion of hospitalizations (ranging from 30.6 to 39.8%). In-hospital mortality was 4.0% in Australia, higher compared to the Netherlands and Denmark (both 1.6%). Not all indicators of the framework were available in all registries.
Patient and ED characteristics and outcomes varied largely across countries. Meaningful interpretation of outcome differences across countries could be improved if quality registries would more consistently register the measures of the recently developed template for uniform reporting.
过去，各国急诊医疗系统配置差异很大，限制了质量和绩效指标比较的价值。此外，缺乏急诊科的定量数据阻碍了对问题的界定以及通过数据驱动改善医疗质量的可能性。因此，目标是使用最近开发的模板，对荷兰、丹麦和澳大利亚的急诊科人群、特征及其结局进行描述和比较，该模板用于统一报告急诊科提供的标准化测量和护理描述（结构、人员配备和治理、人群、流程时间和结局）。
这项国际多中心队列研究纳入了来自三个国家参与机构的国家质量登记处或数据库中的所有连续急诊就诊病例。按国家描述并比较患者和急诊科特征（使用统一报告模板）及相关临床结局。
我们纳入了荷兰的212,515例急诊就诊病例、丹麦的408,673例和澳大利亚的556,652例。患者特征差异显著，与丹麦和荷兰患者相比，澳大利亚急诊科患者更年轻，被分诊为“紧急”的情况较少，因“身体不适”这一高风险主诉被分诊的情况也较少。急诊科特征主要在每个急诊科的年均普查人数方面存在差异（荷兰为26,738例（标准差2630），丹麦为36,675例（标准差12974），澳大利亚为50,712例（4884））、出院回家患者的中位（四分位间距）住院时长（荷兰为2.1小时（1.4 - 3.1小时）；丹麦为2.8小时（1.7 - 5.0小时）；澳大利亚为3.3小时（2.0 - 5.0小时））以及住院比例（范围为30.6%至39.8%）。澳大利亚的院内死亡率为4.0%，高于荷兰和丹麦（均为1.6%）。并非所有登记处都能获取该框架的所有指标。
各国的患者和急诊科特征及结局差异很大。如果质量登记处能更一致地登记最近开发的统一报告模板中的测量指标，那么对各国结局差异的有意义解读将会得到改善。
