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从儿科急诊室不被看到离开:一个新的基线

Brandon Kappy¹, Kenneth McKinley¹, James Chamberlain¹

¹Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia.

The Journal of emergency medicine

|September 2, 2023

概括

在COVID-19限制放松后,儿科急诊部门的未见病患者 (LWBS) 显著增加. 系统因素和患者到达时间与LWBS增加有关,特别是在高急性病例中.

科学领域:

儿科急救医学儿科急救医学
改善医疗保健质量改善医疗保健质量
患者安全患者安全

背景情况:

没有被看到 (LWBS) 率是儿科急诊室 (ED) 的关键质量指标.
高急性LWBS病例构成严重的患者安全风险.
在2021年7月严格的COVID-19隔离措施结束后,我们的儿科ED发生了显著的LWBS激增.

研究的目的:

在不同COVID-19阶段的儿科ED中评估LWBS率的变化.
检查LWBS的系统因素和患者特征之间的关联.
确定减少LWBS在儿科紧急护理中的潜在策略.

主要方法:

对所有抵达大型城市儿科ED的患者进行了回顾性研究.
三个时期的比较:前COVID (2018年1月至2020年2月),早期COVID (2020年3月至2021年6月) 和后COVID变种/季节性病毒 (2021年7月至2021年12月).
使用负双项和逻辑回归模型进行统计分析,以评估与LWBS相关的系统和患者因素.

主要成果:

平均每日LWBS比率从1.8% (COVID前) 大幅增加到10.7% (COVID后).
在后COVID时期,尽管ED体积较低,但LWBS的发病率在所有患者人口统计和分拣水平上升.
与LWBS的显著关联包括紧急严重性指数2分,ED普查的平均值,员工生产力,较低的分拣水平和夜间到达 (8点至凌晨4点).

结论:

自2021年7月以来,儿科ED已经经历了LWBS病例的大量和持续增加,甚至影响到高急性患者.
确定了系统因素和患者特征,为减少LWBS提供了潜在的干预目标.
需要进一步的研究来开发和实施有效的策略,以预防LWBS在危险的儿科群体.

关键词:

在ED操作中,操作是ED操作.拥挤的人群拥挤没有被看到就离开了.没有接受治疗就离开了.儿科儿科儿科儿科

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