中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2011年
10期
1027-1031
,共5页
徐腾达%徐军%吉栩%张晖%孙红%刘继海%杜铁宽%黎波%朱华栋%王仲%于学忠
徐騰達%徐軍%吉栩%張暉%孫紅%劉繼海%杜鐵寬%黎波%硃華棟%王仲%于學忠
서등체%서군%길허%장휘%손홍%류계해%두철관%려파%주화동%왕중%우학충
急诊医学%拥挤%患者流量%流行病学
急診醫學%擁擠%患者流量%流行病學
급진의학%옹제%환자류량%류행병학
Emergency medicine%Overcrowding%Patient flow%Epidemiology%Fast track
目的 通过分析急诊科患者流量和拥挤度变化规律,分析急诊科拥挤度影响因素,找寻客观评估急诊科拥挤度指标.方法 前瞻性队列观察研究,分析一家大型临床教学医院急诊科患者流量和拥挤度变化规律,观察患者流量的24h变化节律和节假日效应、政策效应.并对影响急诊科拥挤度的相关因素进行多因素回归分析.结果 工作日急诊患者流量24h变化规律特征明显,患者流量高峰在20:00-22:00,低谷则在4:00-6:00,而拥挤度评分高峰和低谷滞后2h.急诊患者流量有明显周末和长假日双峰效应,急诊患者流量也受政策性因素影响.多因素回归分析显示时间段内(2 h)急诊来诊人数(B=0.027,P＜0.01)、急诊床位占用率(B=5.25,P＜0.01)与下一个时段急诊科拥挤度显著相关.结论 急诊医疗资源需求具有波动性的,急诊患者流量呈现周期性变化和节假日效应,决策者在着手解决急诊科拥挤问题时需要考虑这一规律.当急诊系统内部和外部环境稳定时,患者流量和急诊床位占用率是预测急诊科拥挤度重要的客观指标.
目的 通過分析急診科患者流量和擁擠度變化規律,分析急診科擁擠度影響因素,找尋客觀評估急診科擁擠度指標.方法 前瞻性隊列觀察研究,分析一傢大型臨床教學醫院急診科患者流量和擁擠度變化規律,觀察患者流量的24h變化節律和節假日效應、政策效應.併對影響急診科擁擠度的相關因素進行多因素迴歸分析.結果 工作日急診患者流量24h變化規律特徵明顯,患者流量高峰在20:00-22:00,低穀則在4:00-6:00,而擁擠度評分高峰和低穀滯後2h.急診患者流量有明顯週末和長假日雙峰效應,急診患者流量也受政策性因素影響.多因素迴歸分析顯示時間段內(2 h)急診來診人數(B=0.027,P＜0.01)、急診床位佔用率(B=5.25,P＜0.01)與下一箇時段急診科擁擠度顯著相關.結論 急診醫療資源需求具有波動性的,急診患者流量呈現週期性變化和節假日效應,決策者在著手解決急診科擁擠問題時需要攷慮這一規律.噹急診繫統內部和外部環境穩定時,患者流量和急診床位佔用率是預測急診科擁擠度重要的客觀指標.
목적 통과분석급진과환자류량화옹제도변화규률,분석급진과옹제도영향인소,조심객관평고급진과옹제도지표.방법 전첨성대렬관찰연구,분석일가대형림상교학의원급진과환자류량화옹제도변화규률,관찰환자류량적24h변화절률화절가일효응、정책효응.병대영향급진과옹제도적상관인소진행다인소회귀분석.결과 공작일급진환자류량24h변화규률특정명현,환자류량고봉재20:00-22:00,저곡칙재4:00-6:00,이옹제도평분고봉화저곡체후2h.급진환자류량유명현주말화장가일쌍봉효응,급진환자류량야수정책성인소영향.다인소회귀분석현시시간단내(2 h)급진래진인수(B=0.027,P＜0.01)、급진상위점용솔(B=5.25,P＜0.01)여하일개시단급진과옹제도현저상관.결론 급진의료자원수구구유파동성적,급진환자류량정현주기성변화화절가일효응,결책자재착수해결급진과옹제문제시수요고필저일규률.당급진계통내부화외부배경은정시,환자류량화급진상위점용솔시예측급진과옹제도중요적객관지표.
Objective To study the variation in numbers of patients attended in the Emergency Department (ER) of a large - scale teaching hospital during weekends or holidays and workdays in order to find out an objective criterion for the assessment of ER overcrowding and the regularity of ER overcrowding.Methods It was a prospective observational study of variation in number of.patient attended in ER during different periods of time round the clock observed from May 1 through October 31 in 2008 -2010 with 110000 emergency patients annually.The roles of diurnal rhythm,holiday phenomenon and medical coverage in the variation in numbers of patients were observed.The multiple logistic regression analysis was used to define the criterion of ED overcrowding.Results During workdays,the regularity of variation in number of critically ill patients seen to in ER was distinctive,the number of patients peaked in the period of 20:00 -22:00 and bottomed out in the period of 4:00 -6:00,while overcrowding scores of both peak and bottom were carried out 2 hours later.The number of emergency patients significantly increased at weekends and long holidays in a form of double peaks,from 10 am to 12 pm and 8 pm to 10 pm.The number of emergency patients was obviously determined by the provisions of medical coverage,but it was only true to non - critical patients,while the number of critical patients did not noticeably change during weekends or holydays.Multivariate regression analysis showed that the number of emergency patient attended in ER ( B =0.027,P ＜0.01 ) and the rate of emergency bed occupancy ( B =5.25,P ＜0.01 ) in the period of two hours significantly correlated with the ER overcrowding in the coming period of two hours (B =0.027,P ＜0.01,B =5.25,P ＜ 0.01,respectively).Conclusions The demand for critical care resources varies up and down all the time.The variation in volume of critical patients is quite regular during workdays and weekdays or holydays.It is important to separate critical patients from non - critical patients in order to divert non - critical patients quickly.Prediction of overcrowding in ER can be made with knowledge of the number of patient attended and the rate of bed occupancy,if the provisions of medical coverage unchanged.This regularity of variation in number of patients can be used as a practical guidance to rational allocation of critical care resources and improvement of patient throughput.
