全民免费:由于医院急诊室没有有效地确定优先级,拥挤是否会影响结果?
Igor Francetic1, Rachel Meacock1, Matt Sutton1
1University of Manchester (UK).
Journal of health economics
|April 16, 2024
概括
来自低严重性患者的医院拥挤对高严重性患者的护理影响最小. 对患者结果的显著负面影响仅发生在极端需求激增期间,这表明急诊室 (ED) 有效的优先级.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 紧急医疗 紧急医疗
- 卫生经济学 卫生经济学
背景情况:
- 医院急诊室 (ED) 经历了不可预测的患者数量激增.
- 在EDs的拥挤可能会对患者的等待时间,护理强度和健康结果产生负面影响.
- 讨论了拥挤影响的原因:临床优先级效率与容量限制.
研究的目的:
- 调查低重症患者的拥挤是否会影响高重症患者的护理途径和结果.
- 确定ED拥挤效应是否源于优先级问题或容量限制.
- 在不同需求下,评估EDs患者优先级的效率.
主要方法:
- 在英格兰140个公共急救中心分析了大约1300万例患者出院情况 (2016年4月至2017年3月).
- 利用高维固定效应来控制计划中的ED容量.
- 检查了来自低严重性患者的意外需求对高严重性患者结局的影响.
主要成果:
- 低重症患者的意外需求对高重症患者的护理影响最小.
- 对较重症患者的有害影响仅在非常高水平的意想不到的需求时发生.
- 低重度患者的拥挤效应小于高重度患者的拥挤效应,这表明有效的优先级.
结论:
- 紧急救护医生似乎有效地优先考虑患者,因为低严重性需求对高严重性病例的不良影响有限.
- 有约束力的资源限制只有在需求大大超过预期水平时,才会对患者护理产生重大影响.
- 研究结果表明,ED可以有效地管理患者流动,减轻中度拥挤的负面后果.
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