应急部门住院,住院人口普查和医院间转移的接受
Margaret Greenwood-Ericksen1, Neil Kamdar2,3,4, Kjirsten Swenson1
1Department of Emergency Medicine, School of Medicine, University of New Mexico, Albuquerque.
JAMA network open
|May 28, 2025
概括
医院拥挤,通过急诊室入院和住院人口普查来衡量,显著减少了医院间转移的接受. 这影响了患者获得专业护理的机会,特别是在农村和高优先级病例中.
科学领域:
- 医疗保健管理的管理
- 医疗保健服务研究 医疗服务研究
- 患者获得护理的机会
背景情况:
- 美国转诊医院面临越来越多的拥挤,导致医院间转诊 (IHT) 拒绝请求的增加.
- 医院拥挤对患者安全构成风险,并挑战了转诊中心的核心功能.
- 拒绝IHT可以破坏患者护理途径,并可能导致不良结果.
研究的目的:
- 量化医院拥挤指标 (急诊室 [ED] 住院和住院人口普查) 与IHT接受率之间的关联.
- 检查拥挤如何影响一般病例和优先医疗条件的IHT接受.
- 在医院拥挤的背景下,分析农村对IHT接受的影响.
主要方法:
- 横截面研究分析了来自美国西南部农村州一级创伤中心的26,020个IHT请求 (2019年1月 - 2023年5月).
- 数据包括转移中心记录,每日ED登机时间和住院人口普查.
- 调整后勤回归评估了拥挤措施与IHT接受度之间的关系,控制优先条件和乡村性.
主要成果:
- 总体而言,IHT的接受率为61.7% (在26,020个请求中接受了16062个).
- 增加ED登机和住院人口普查与IHT接受度有负相关性 (Pearson r = 分别为-0.73和-0.87).
- 更高的ED登机率与IHT接受率较低相关 (aOR,0.71). 与城市相比,农村请求的接受率较低 (aOR,0.66).
- 产科,STEMI和创伤等优先条件的接受率明显更高.
结论:
- 严重的医院拥挤,由ED登机和住院人口普查表明,显著减少接受医院间转移请求.
- 过度拥挤的转诊医院必须平衡对现有患者的护理与接受新转移,从而创造了一个关键的运营挑战.
- 调查结果强调,需要制定战略来缓解医院拥挤情况,并确保公平获得专业护理,特别是在农村人口和危急条件下.
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