Fromm R E, Gibbs L R, McCallum W G, Niziol C, Babcock J C, Gueler A C, Levine R L
Department of Emergency Services, Methodist Hospital, Houston, TX.
Crit Care Med. 1993 Jul;21(7):970-6. doi: 10.1097/00003246-199307000-00009.
Emergency departments serve many functions in the current U.S. healthcare system, including initial management of patients with critical illnesses and primary care for a growing proportion of the population. Overcrowding of emergency departments is a growing problem. Delays in admitting patients to inpatient units have been reported as a contributing factor to overcrowding. To date, the effect of the critically ill patients on the emergency department has not been fully described. It was the purpose of this study to examine the incidence of critical illness in the emergency department and its total burden as reflected in emergency department length of stay.
Prospective, cohort study in 17,900 emergency department patients.
Single, not-for-profit teaching hospital.
All patients admitted to the emergency department during the period of April 1, 1991 to March 31, 1992.
None.
Date and time of arrival in the emergency department and time of discharge, death, or admission to an inpatient unit were recorded. Patients admitted to intensive care units/special care units from the emergency department were defined as critically ill. All other patients were classified as noncritically ill. Emergency department length of stay was calculated as the time from arrival in the emergency department until discharge, death, or admission to an inpatient unit. Differences in length of stay were determined using Kruskal-Wallis analysis by ranks. The study population totaled 17,900 patients: 8.5% (n = 1,527) critically ill patients, 61.1% (n = 10,930) discharged patients, and 30.4% (n = 5,443) noncritically ill admitted patients. Mean emergency department length of stay for the critically ill patients was 145.3 +/- 89.6 mins (maximum length of stay, 655 mins), and for the noncritically ill patients, mean stay was 153.1 +/- 91.9 mins (maximum length of stay, 781 mins) (p < .0003). During the study period, 154 patient-days of emergency department critical care were provided.
Critically ill patients constitute an important proportion of emergency department practice and may remain in the emergency department for significant periods of time. Solutions to emergency department overcrowding may include alternatives for continuing management of critically ill patients. Given the realities of emergency department practice, emergency medicine practitioners should receive training in the continuing management of critically ill patients.
在美国当前的医疗体系中，急诊科承担着多种功能，包括对危重病患者的初始管理以及为越来越多的人群提供初级保健服务。急诊科过度拥挤是一个日益严重的问题。据报道，患者入住住院病房的延迟是导致过度拥挤的一个因素。迄今为止，危重病患者对急诊科的影响尚未得到充分描述。本研究的目的是调查急诊科危重病的发生率及其在急诊科住院时间所反映的总体负担。
对17900名急诊科患者进行前瞻性队列研究。
一家非营利性教学医院。
1991年4月1日至1992年3月31日期间入住急诊科的所有患者。
无。
记录患者到达急诊科的日期和时间以及出院、死亡或入住住院病房的时间。从急诊科转入重症监护病房/特殊护理病房的患者被定义为危重病患者。所有其他患者被归类为非危重病患者。急诊科住院时间计算为从到达急诊科到出院、死亡或入住住院病房的时间。使用Kruskal-Wallis秩和检验分析住院时间的差异。研究人群共有17900名患者：8.5%（n = 1527）为危重病患者，61.1%（n = 10930）为出院患者，30.4%（n = 5443）为非危重病住院患者。危重病患者的急诊科平均住院时间为145.3±89.6分钟（最长住院时间为655分钟），非危重病患者的平均住院时间为153.1±91.9分钟（最长住院时间为781分钟）（p <.0003）。在研究期间，共提供了154个急诊科重症监护患者日。
危重病患者占急诊科业务的重要比例，并且可能在急诊科停留较长时间。解决急诊科过度拥挤的办法可能包括为危重病患者的持续管理提供替代方案。鉴于急诊科业务的实际情况，急诊医学从业者应接受危重病患者持续管理方面的培训。
