在ED中取消4小时访问标准的效果:一项追溯观察性研究
Tomas Momesso1, Bilal Gokpinar2, Rouba Ibrahim2
1UCL School of Management, University College London, London, UK tomas.momesso.20@ucl.ac.uk.
Emergency medicine journal : EMJ
|June 27, 2023
概括
取消4小时的急诊室 (ED) 准入标准减少了短期住院的入院人数,但增加了ED总体停留时间. 这一变化对患者群体的影响不同,有些人避免入院,而另一些人则经历了更长的等待时间.
科学领域:
- 紧急医疗 紧急医疗
- 医疗服务研究 医疗服务研究
- 医疗保健政策 医疗保健政策
背景情况:
- 基于时间的目标,如4小时访问标准,在急诊室 (ED) 广泛使用,以管理患者流量并提高护理质量.
- 虽然这些目标是有益的,但也可能导致意外的负面后果.
- 本研究调查了在英语ED中删除4小时访问标准的具体影响.
研究的目的:
- 评估取消急诊室4小时门禁标准的后果.
- 评估对入院率,停留时间和救护车交付时间的影响.
主要方法:
- 采用了回顾性观察性研究设计,分析来自英国国家卫生服务 (NHS) 的单一患者级数据.
- 数据是在取消4小时访问标准之前和之后收集的,涵盖2018年4月至2019年12月的时间.
- 使用中断时间序列模型分析了主要结果的变化:入院率,ED停留时间和救护车交付时间.
主要成果:
- 这项分析包括169,916例患者出院.
- 取消4小时标准与平均每日入院率从35%下降到31%的统计学上显著下降有关,特别是在Majors (Ambulant) 和短期入院方面.
- 相反,入院患者 (316至387分钟) 和出院患者 (222至262分钟) 在ED的平均逗留时间增加.
结论:
- 取消4小时入院标准导致短期住院患者数量减少,但ED平均住院时间显著增加.
- 影响在不同患者群体之间有所不同;一些患者,如患有不太严重疾病的Majors (行走者) 患者,可能通过避免不必要的入院而受益.
- 然而,ED停留时间的总体增加,特别是在老年和住院患者中,表明超出预期范围的潜在系统范围的后果.
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