Devia-Jaramillo German, Esmeral-Zuluaga Nathalia, Vargas-Gallo Juan Pablo, Alfonso-Cristancho Rafael
Fundación Santa Fe de Bogotá.
School of Medicine and Health Sciences Universidad del Rosario, Bogotá, Colombia.
J Health Econ Outcomes Res. 2025 May 30;12(1):207-212. doi: 10.36469/001c.130031. eCollection 2025.
Overcrowding is persistent in emergency departments (EDs) worldwide and can result in adverse patient outcomes and prolonged lengths of stay. Delays in care and unmet demand contribute to negative outcomes for patients awaiting treatment, including increased morbidity and mortality, prolonged hospital stays, and overall lower quality of medical care. Overcrowding in EDs not only diminishes patient satisfaction with the entire hospitalization experience, beyond the ED, but also significantly increases healthcare costs and contributes to a rise in medical errors. Therefore, developing strategies that optimize the limited resources available for emergency patient care, especially for those with low-complexity emergencies, is crucial. To evaluate whether implementing a specific care strategy for patients with low-complexity emergencies can effectively reduce costs and improve clinical outcomes and patient-reported experiences compared with standard care practices. A cost-consequence model was employed to separately evaluate the costs and outcomes of each alternative. The cost and outcome analyses were applied to healthcare services using the database of a tertiary-level ED, analyzed from the perspective of the healthcare service provider over a 2-year time horizon. To assess the perspective of the healthcare provider institution, the cost-consequence analysis was conducted using a decision tree model. The study included 43 268 patients. No significant differences were found in demographic variables between groups. A significant difference was found in total length of stay in minutes between groups: minimum (median interquartile range [IQR]), 534 (456-644) vs 494 (364-719) ( < .001). In addition, there was an improvement in the NPS value from 44 to 53 throughout the ED, with 0.005% mortality in the study group and 0.07 in the control group ( < .001). Finally, a significant difference was documented in the mean billing per patient, with a median (IQR) of Col 151 108-Col 283 922 (Col 776 097) ( < .018). The implementation of a specialized unit for the care of patients with low-complexity emergencies within the ED has proven effective in improving total patient length of stay. This significantly contributes to reducing overcrowding, decreasing mortality, and reducing unmet demand. As a result, there is an overall improvement in user satisfaction within the ED.
急诊室人满为患的情况在全球范围内长期存在，可能导致不良的患者结局以及住院时间延长。护理延误和需求未得到满足会给等待治疗的患者带来负面后果，包括发病率和死亡率增加、住院时间延长以及整体医疗质量下降。急诊室人满为患不仅会降低患者对整个住院体验（超出急诊室范围）的满意度，还会显著增加医疗成本，并导致医疗差错增多。因此，制定优化急诊患者护理可用有限资源的策略至关重要，尤其是针对低复杂性急诊患者。为了评估与标准护理实践相比，为低复杂性急诊患者实施特定护理策略是否能有效降低成本、改善临床结局以及患者报告的体验。采用成本后果模型分别评估每种方案的成本和结局。成本和结局分析应用于使用三级急诊室数据库的医疗服务，从医疗服务提供者的角度在两年时间范围内进行分析。为了评估医疗服务提供者机构的观点，使用决策树模型进行成本后果分析。该研究纳入了43268名患者。两组之间在人口统计学变量上未发现显著差异。两组之间在住院总时长（分钟）上发现了显著差异：最短（中位数四分位间距[IQR]），534（456 - 644）对494（364 - 719）（<0.001）。此外，整个急诊室的净推荐值（NPS）从44提高到了53，研究组的死亡率为0.005%，对照组为0.07%（<0.001）。最后，记录到每位患者的平均计费存在显著差异，中位数（IQR）为151108 - 283922哥伦比亚比索（776097哥伦比亚比索）（<0.018）。在急诊室内设立专门护理低复杂性急诊患者的单元已被证明在改善患者总住院时长方面是有效的。这对减少人满为患、降低死亡率以及减少需求未得到满足的情况有显著贡献。结果，急诊室内的用户满意度总体有所提高。
