荷兰急诊科患者的特征及其在急性护理链中的就医过程：一项全省范围的快闪研究。
Characteristics of Dutch ED patients and their journey through the acute care chain: A province-wide flash-mob study.
作者信息
Claassen Lieke, Stassen Patricia Maria, Boumans Thimo Jozef Theresia, Barten Dennis Gerard, Kremers Marjolein Nel Tinie, Hermans Anne Maria Elisa, Zelis Noortje, Cals Jochen Wilco Lennert, Latten Gideon Hubertus Petrus
机构信息
Department of Emergency Medicine, Zuyderland Medical Centre, Heerlen, The Netherlands.
Section Acute Medicine, Division General Medicine, Department of Internal Medicine, CARIM School of Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.
出版信息
PLoS One. 2025 Apr 3;20(4):e0318510. doi: 10.1371/journal.pone.0318510. eCollection 2025.
BACKGROUND
Insight in characteristics and journey of patients in the Acute Care Chain (ACC) who visit the Emergency Department (ED) is lacking. Existing studies focus on prespecified (time-sensitive) complex conditions like major trauma and stroke, and on the hospital phase. This study provides a representative overview of adult ED patients and their journey through the ACC with focus on differences between those with and without prespecified complex conditions.
METHODS
A prospective 72-hour flash-mob study was conducted in 2022 across all six EDs in the province of Limburg, the Netherlands, encompassing unselected adult patients. Baseline characteristics, journey, and time within ACC were collected. Patients with a prespecified complex condition (stroke, myocardial infarction, aortic syndrome and major trauma) were compared to those without.
RESULTS
Out of 794 adult ED patients, 585 (73.7%) were included. Patients reported symptoms for a median of 1 day (IQR 0-4) before their ED visit; 56.3% encountered ≥ 1 healthcare provider. General practitioners referred 56.1% of patients, and emergency medical services transported 32.9%. The median time in ACC was 5.0 hours (IQR 3.5-6.9), with 3.0 hours (IQR 2.0-4.2) spent in the ED. The three most prevalent presenting complaints were minor trauma (28.5%), abdominal pain (14.6%) and dyspnoea (12.5%), while 9.3% presented with prespecified complex conditions. Patients with a prespecified complex condition were more often triaged highly urgent (53.6% vs 13.9%, p < 0.001) and received a complex work-up (79.6% vs 41.2%, p < 0.001).
CONCLUSION
In our province-wide study, ED patients had symptoms for 1 day and over half of them already contacted a healthcare provider. Time in ACC was 5 hours, with a substantial proportion of time spent prehospitally. Prespecified complex conditions accounted for less than 1 in 10 ED patients. These findings highlight that, to optimise care and care policy, it is essential to examine the entire ACC for unselected patients.
TRIAL REGISTRATION
ClinicalTrials.gov NCT06079099.
背景
目前缺乏对急性护理链（ACC）中前往急诊科（ED）就诊患者的特征及就医过程的了解。现有研究主要聚焦于预先确定的（对时间敏感的）复杂病症，如重大创伤和中风，且多关注医院阶段。本研究提供了成年急诊科患者及其在急性护理链中的就医过程的代表性概述，重点在于有和没有预先确定的复杂病症的患者之间的差异。
方法
2022年在荷兰林堡省的所有六个急诊科开展了一项为期72小时的快闪研究，纳入未经过筛选的成年患者。收集了患者的基线特征、就医过程以及在急性护理链中的时间。将患有预先确定的复杂病症（中风、心肌梗死、主动脉综合征和重大创伤）的患者与未患此类病症的患者进行比较。
结果
在794名成年急诊科患者中，585名（73.7%）被纳入研究。患者在前往急诊科就诊前症状出现的中位时间为1天（四分位间距0 - 4天）；56.3%的患者曾接触过≥1名医疗服务提供者。全科医生转诊了56.1%的患者，紧急医疗服务运送了32.9%的患者。在急性护理链中的中位时间为5.0小时（四分位间距3.5 - 6.9小时），其中在急诊科花费的时间为3.0小时（四分位间距2.0 - 4.2小时）。最常见的三种就诊主诉为轻度创伤（28.5%）、腹痛（14.6%）和呼吸困难（12.5%），而9.3%的患者患有预先确定的复杂病症。患有预先确定的复杂病症的患者更常被分诊为高度紧急（53.6%对13.9%，p < 0.001），并接受复杂的检查（79.6%对41.2%，p < 0.001）。
结论
在我们这项全省范围的研究中，急诊科患者症状出现1天，超过半数患者已联系过医疗服务提供者。在急性护理链中的时间为5小时，其中相当一部分时间花费在院前。预先确定的复杂病症在每10名急诊科患者中所占比例不到1例。这些发现凸显出，为优化护理及护理政策，对未经过筛选的患者检查整个急性护理链至关重要。
试验注册
ClinicalTrials.gov NCT06079099
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