Sinclair D, Green R
Division of Emergency Medicine, Dalhousie University, Queen Elizabeth Health Sciences Centre, Halifax, Nova Scotia, Canada.
Ann Emerg Med. 1998 Dec;32(6):670-5. doi: 10.1016/s0196-0644(98)70065-4.
We sought to test the assumption that an emergency department observation unit can be funded through the reallocation of resources made available through the unit's impact in reducing inpatient admissions and facilitating bed closures.
We conducted our study in a tertiary care center ED with 46,000 visits annually. For a 3-month period, all patients admitted to the hospital through the ED were screened by an emergency physician for suitability for admission to an observation unit. Any patient in the hospital for 3 days or less who did not undergo surgery or other inpatient procedure, and who was admitted through the ED, was considered a candidate for the observation unit.
Of 1,840 admissions, 147 patients met the admission criteria. Only 48 (32.2%) could have been treated in an observation unit, and these patients were not admitted to any single unit in high frequency. The potential savings from inpatient bed closures would only have amounted to 1.68 full-time equivalents-not enough to staff a 4-bed observation unit, which would require 5 full-time equivalents.
Because of the diffuse and inconsistent effect such a unit had on inpatient bed use, funding for an ED observation unit at our institution could not be justified on the basis of the closure of inpatient beds and transfer of resources.
我们试图检验这样一种假设，即急诊科观察单元可以通过重新分配因该单元在减少住院患者入院人数和促进床位关闭方面的作用而获得的资源来提供资金。
我们在一家每年有46000人次就诊的三级护理中心急诊科进行了研究。在为期3个月的时间里，所有通过急诊科入院的患者均由一名急诊医生筛查是否适合入住观察单元。任何在医院住院3天或更短时间、未接受手术或其他住院治疗且通过急诊科入院的患者均被视为观察单元的候选对象。
在1840例入院患者中，147例符合入院标准。其中只有48例（32.2%）可以在观察单元接受治疗，而且这些患者并非高频入住任何单一单元。关闭住院床位可能节省的费用仅相当于1.68个全职等效岗位——不足以配备一个4张床位的观察单元，该单元需要5个全职等效岗位。
由于这样一个单元对住院床位使用的影响分散且不一致，基于关闭住院床位和资源转移，我们机构的急诊科观察单元无法获得资金支持。
