Davis B, Sullivan S, Levine A, Dallara J
Department of Emergency Medicine, Duke University Medical Center, Durham, NC 27710, USA.
Am J Emerg Med. 1995 Sep;13(5):495-500. doi: 10.1016/0735-6757(95)90155-8.
To determine what patient characteristics are associated with prolonged emergency department (ED) length-of-stay (LOS) for surgical critical care patients, the charts of 169 patients admitted from the ED directly to the operating room (OR) or intensive care unit (ICU) during a 6-week period in 1993 were reviewed. The ED record was reviewed for documentation of factors that might be associated with prolonged ED LOS, such as use of computed tomographic (CT), radiology special procedures, and the number of plain radiographs and consultants. ED LOS was considered to be the time from triage until a decision was made to admit the patient. Using a Cox proportional hazards model, use of CT and special procedures were the strongest independent predictors of prolonged ED length-of-stay. The number of plain radiographs and consultants had only a minimal effect. Use of a protocol-driven trauma evaluation system was associated with a shorter ED LOS. In addition to external factors that affect ED overcrowding, ED patient management decisions may also be associated with prolonged ED length-of-stay. Such ED-based factors may be more important in surgical critical care patients, whose overall ED LOS is affected more by the length of the ED work-up rather than the time spent waiting for a ICU bed or operating suite.
为了确定哪些患者特征与外科重症监护患者在急诊科（ED）的住院时间延长有关，我们回顾了1993年6周内从急诊科直接收治到手术室（OR）或重症监护病房（ICU）的169例患者的病历。查阅急诊记录，以了解可能与急诊科住院时间延长相关的因素，如计算机断层扫描（CT）、放射科特殊检查的使用情况，以及普通X线片数量和会诊医生数量。急诊科住院时间被定义为从分诊到决定收治患者的时间。使用Cox比例风险模型，CT和特殊检查的使用是急诊科住院时间延长的最强独立预测因素。普通X线片数量和会诊医生数量的影响很小。使用协议驱动的创伤评估系统与较短的急诊科住院时间相关。除了影响急诊科过度拥挤的外部因素外，急诊科患者管理决策也可能与急诊科住院时间延长有关。此类基于急诊科的因素在外科重症监护患者中可能更为重要，他们在急诊科的总体住院时间更多地受急诊科检查时间的影响，而非等待重症监护病床或手术室的时间。
