上海市14所医院急诊科现况调查

本文通过对上海市14所医院急诊科的现状调查，从机构设置、仪器装置、人员状况和管理体制等方面进行分析，探索影响急诊专科发展之因素。文章认为要促进我国急诊专业形成，必须要有急诊专业发展的基础条件，亦即加强急诊科建设，关键要建立健全组织管理体制，重点要配备符合急诊医疗工作要求的医护人员。并提出了建设和发展急诊科的设想以及提高急诊队伍素质、改善急诊医务人员待遇等建议。     

急诊医疗在我院的实践

为探讨急诊医疗在医院建设中的作用，本介绍了该院急诊科的建设与发展情况；阐述了急诊科的发展有赖于思想观念的转变；急诊人才培养；急诊专业的定位。     

省级医院急诊科设立外科组的实践与探索

省级医院急诊科设立外科组的实践与探索昆明医学院第一附属医院姚越苏，刘一波，王宏一、回顾我院于１９８２年在急诊室基础上成立了急诊科，１９８６年在急诊科内设立了急诊外科组，１９９０年在抢救观察室的基础上，又设立了急诊住院部及独立的外科急诊手术室、清创室、...     

医院急诊工作存在的问题和对策

目前，许多医院的急诊工作状况与医院的规模和功能不相适应，主要存在以下问题：急诊科没有固定医务人员；急诊科医护人员少，工作忙乱；急诊医师急救能力不高；急诊科工作制度不健全。     

浅谈基层综合性医院急诊科的发展与管理

笔者就基层综合性医院急诊科的发展与管理，从建立和健全各种规章制度，确保急救生命绿色通道的畅通；引用高科技手段加强急诊科管理；标准化、程序化地开展急诊和急救工作；加强对急诊人才的培训，提高医护人员综合素质，加强对各级医生的法制教育，增强法律意识形态，提高急诊病历的书写质量；更新观念，本着一切以患者为中心的理念，不断提高急诊科的综合服务水平等几方面做出了较为详细的阐述。     

我省综合医院急诊科（室）分级管理标准

为了规范急诊科的建设与管理，适应广大人民群众对急诊医疗的需要，按照医院级别，对急诊科从科室设置、建筑、管理、制度、人员配备、器材与药品、科研与教学、工作质量８大方面提出了管理标准。     

彝族地区县级医院急诊科医生工作及身心压力调查分析

目的：通过对凉山彝族地区县级医院急诊科医生工作压力状况的调查,探讨急诊医生工作压力对身心健康的影响。方法：采用整群抽样方法,抽取凉山彝族地区县级医院64名急诊科医生和55名普通医生,分别对其进行问卷调查,了解其工作压力源、心理健康状况。结果：县级医院急诊科与普通医生在专业信心和医疗自我满意度方面,工作量和工作环境方面,人际关系、情感及思维方式等方面比较差异均有统计学意义（P〈0．05）。结论：凉山彝族地区县级医院急诊科医生工作压力大,建议全社会和卫生主管部门重视急诊科医生,采取有效的措施,改善急诊工作环境,维护急诊科医生的健康。     

加强急诊科管理 提高急救医疗质量

加强急诊科管理提高急救医疗质量万建华李继光作者单位：１１０００１沈阳市，中国医科大学附属第一医院随着医疗体制的改革，医院内部医疗结构的调整，急诊模式的转变也势在必行。为适应现代急诊急救医学的发展，更好地满足急诊患者的医疗要求，我们在改变急诊模式方面做...     

急诊医生的素质培养

急诊科是医院中抢救急危重患者生命最紧张、最繁忙的部门，担负着院前急救、院内接诊、紧急处置与院内各科的联系等职责。急诊医生在急诊工作中担负着重要角色，要正确处置患者，协调各种关系。特别是当前患者维权意识增强，医患纠纷隐患层出不穷，要求急诊医生具备良好的基本素质，是做好急诊工作的重要保证。急诊医生的素质培养，关系到急诊急救工作的质量，关系到一个医院乃至一个地区急诊急救的工作水平，甚至影响着整个医疗卫生事业的发展。重视急诊医生的素质培养，是急诊科管理的重点，也是整个医院发展的重要部分。     

急诊外科建设在应对突发公共卫生事件中的作用

2003年突如其来的SARS疫情暴露了我国公共卫生体系在应对突发公共卫生事件方面存在着一些突出问题，也反映了我国综合性医院急诊管理制度的种种弊端，现行的急诊医疗模式不能适应现代社会经济的发展，而加强和完善急诊科的建设是应对突发公共卫生事件的基础建设应成为我们的共识，作为急诊科的重要组成部分急诊外科的建设在应对突发公共卫生事件中的作用更加引人注目。     

Emergency contraception in emergency departments in Oregon, 2003

OBJECTIVES: We sought to learn about access to emergency contraception (EC) in Oregon emergency departments, both for women who are rape patients and for women who have had consensual unprotected sexual intercourse ("nonrape patients"). METHODS: We interviewed emergency department staff in 54 of Oregon's 57 licensed emergency departments in February-March 2003 (response rate = 94.7%). RESULTS: Only 61.1% of Oregon emergency departments routinely offered EC to rape patients. Catholic hospitals were as likely as non-Catholic hospitals to routinely offer EC to rape patients. The hospitals most likely to routinely offer EC to rape patients had a written protocol for the care of rape patients that included offering EC (P = .02) and access to staff with specialized sexual assault training (P=.002). For nonrape patients, 46.3% of emergency departments discouraged the prescribing of EC. Catholic hospitals were significantly less likely than non-Catholic hospitals to provide access to EC for nonrape patients (P=.05). CONCLUSIONS: Oregon emergency departments do not routinely offer EC to women who have been raped or to women who have had consensual unprotected sexual intercourse.     

Physician Staffing of Small Rural Hospital Emergency Departments: Rapid Change and Escalating Cost

We surveyed all 37 rural Washington state hospitals with fewer than 100 beds to determine how rural emergency departments are staffed by physicians and to estimate rural hospital payments for emergency department physician services. Only five hospital emergency departments (14%) were still covered by the traditional rotation of local practitioners and billed on a fee-for-service basis. Ten hospitals (27%) paid local private practitioners to provide emergency department coverage. Twelve other hospitals (32%) hired visiting emergency department physicians to cover only weekends or evenings. The remaining 10 rural emergency departments (27%) were staffed entirely by external contract physicians. Thus, 86 percent of rural hospitals contracted for emergency department coverage, and 59 percent obtained some or all of this service from nonlocal physicians. Most of the 32 hospitals with some form of contracted services have changed to this emergency department coverage in the last few years. The cost of these services is high, particularly for the smallest hospitals that have fewer than eight emergency department visits per day and pay physician wages of nearly $100 per patient visit. Emergency staffing responsibility has shifted from local practitioners to the hospital administrators because of rural physician scarcity and a desire to improve quality and convenience. The cost of these changes may further undermine the economic viability of the smaller rural hospitals.     

The future of community-centred health services in Australia - an alternative view

Community-centred healthcare works in conjunction with hospital-centred healthcare. Both have strengths and limitations. Community-centred healthcare has been demonstrated to be a more cost-efficient and cost-effective alternative to hospital-centred care at best in a limited fashion. If hospital-centred services dominate healthcare services in Australia, as argued previously in this journal, then this has not extended to maintenance of inpatient bed provision. The author, as a hospital-based emergency specialist, has observed case load and models of care in hospitals and emergency departments for 30 years and is sceptical of promises to substantially further decrease emergency department demand and acute bed requirements. The real benefits of community, primary and preventive care should not be over sold.     

Estimating Uncompensated Care Charges at Rural Hospital Emergency Departments

CONTEXT: Rural hospitals face multiple financial burdens. Due to federal law, emergency departments (ED) provide a gateway for uninsured and self-pay patients to gain access to treatment. It is unknown how much uncompensated care in rural hospitals is due to ED visits. PURPOSE: To develop a national estimate of uncompensated care from patients utilizing the ED in rural hospitals. METHODS: Clinical data from the National Hospital Ambulatory Medical Care Survey-ED (NHAMCS-ED) from 1999 and 2000 were linked to billing data from South Carolina. National estimates of utilization and charges were calculated, with rurality and self-pay status being the variables of focus. FINDINGS: Applying South Carolina billing data to national clinical data yields a national estimate for 1999-2000 of nearly $441 billion in charges being generated through emergency departments, with self-pay patients representing 9.0% of total charges. Rural self-pay patients accounted for an estimated $3.5 billion in charges in 1999 and $5.3 billion in 2000. These charges may represent a total financial burden of more than $4 billion to rural hospitals. CONCLUSIONS: Efforts should be made to reduce the uncompensated care burden on rural hospitals to ensure their viability. These efforts may include Medicaid/SCHIP expansions, FQHCs or RHCs, Critical Access Hospital Designation, or other indigent care programs that would reduce the need for self-pay patients to utilize EDs.     

Hospital-sponsored primary care: II. Impact on patient access

This article, the second of two, considers the impact of a nationwide demonstration of 53 community hospital sponsored group practices (CHPs). Surveys of a sample of the communities in which the CHPs were introduced suggest that about half of the communities were socioeconomically and, to some extent, medically disadvantaged. The CHPs tended to attract people who had previously not had a regular source of care or who used hospital outpatient departments or emergency rooms, as well as patients of established primary care physicians. Access to care and satisfaction appeared to be as good or better for CHP patients compared to regular patients of physicians in the target areas. The programs did not increase the use of inpatient services, emergency rooms, or hospital outpatient departments. The findings suggest that at present community hospital sponsored group practices would not have a profound effect on access to care if adopted nationally, but that targeted implementation by hospitals in lower income and minority communities can improve patient opportunities for appropriate primary care services.     

Medical Scribes: The Future for Medical Data Input in Emergency Departments

Despite their widespread use, electronic medical records have created frustrations for physicians, especially those working in busy hospital emergency departments. After a brief discussion of the causes of the problems, a potential solution—the use of medical scribes—is presented. The extant literature regarding results obtained following the implementation of medical scribes in emergency departments is reviewed and some conclusions regarding the future of this phenomenon are presented. The future looks quite bright for use of medical scribes in hospitals’ emergency departments.     

California hospitals serving large minority populations were more likely than others to employ ambulance diversion

It is well documented that racial and ethnic minority populations disproportionately use hospital emergency departments for safety-net care. But what is not known is whether emergency department crowding is disproportionately affecting minority populations and potentially aggravating existing health care disparities, including poorer outcomes for minorities. We examined ambulance diversion, a proxy measure for crowding, at 202 California hospitals. We found that hospitals serving large minority populations were more likely to divert ambulances than were hospitals with a lower proportion of minorities, even when controlling for hospital ownership, emergency department capacity, and other hospital demographic and structural factors. These findings suggest that establishing more-uniform criteria to regulate diversion may help reduce disparities in access to emergency care.     

Patient satisfaction survey in emergency departments in acute care hospitals

OBJECTIVE: To describe patient satisfaction with emergency care of different hospitals. METHODS: patients attended in emergency departments of nine acute hospitals. A patient satisfaction questionnaire was used which includes relevant areas for patients and emergency departments workers 1,940 patients were selected to be surveyed by phone, by previously trained interviewers. RESULTS: 1, 423 patients were interviewed. They reported that mean waiting time until were seeing by the physician ranged from 20 to 60 minutes and total time at the emergency room from 60 to 170 minutes. Interviewees negative ratings for both were of 38% and 36% respectively. Information given about the problem of the patient was negatively rated by 6 to 17%, and about the treatment to follow by 8 to 16% of them. 5% referred not getting information on the latest. Up to 30% of patients said not were clearly informed of the results of the test performed Interpersonal care was positively rated in 55% of cases in some hospitals. Global evaluation gave positive ratings of 58% and negatives of 14%. CONCLUSIONS: This survey detect significant differences among all the centers in the study. Waiting time area showed the greater differences among them. Also the worst qualifications, followed by information to patient. Patient satisfaction questionnaires may work as aid in detecting health care problems.     

SARS引发急诊影像设备配置的思考

目的 了解急诊影像设备配置的现状和存在的问题，探讨合理的配置方案。方法 对在京的20所三级甲等综合医院急诊、门诊和住院部的布局以及相关影像设备的配置做实地调查，尤其注意急诊室的配置。急诊设备分专属和共享两类。共享设备与急诊室的距离分较近和较远两种情况。按此分类进行统计，筛选优化配置和分析存在的问题。结果 5所医院急诊有专属X线照像机，15所与门诊共享，其中8所照像室离急诊较远。4所医院急诊有专属CT机，7所急诊与CT室距离较远。20所医院均无专属磁共振仪，其中14所磁共振距急诊较远。结论 三级甲等医院急诊室影像设备配置尚不理想。合理配置应根据医院规模、特色、拥有设备数量以及急诊与门诊放射科的距离等因素综合考虑。     

Uncompensated care and emergency department utilization: a local study having national implications

This article provides a comprehensive picture of the manner in which uncompensated care patients utilize the emergency departments (EDs) of two Central Florida hospitals. Specifically, this study assesses the impact of treating uncompensated and primary care patients in ED settings on scarce hospital and community resources. Recommendations are being offered to manage a troubling situation that is occurring with alarming frequency in today's health care system throughout the United States. Special emphasis is placed on recommendations addressing alternative triage and financing models that are considered to be both socially responsible and economically viable. The results of this study suggest strongly that health care organizations must find an alternative to the current trend in ED utilization, in order to meet the primary care needs of patients and not compromise the care provided to those with emergent conditions. The recommendations emanating from this study outline a mechanism that can improve the timeliness of emergency care to those in need, while at the same time, making available primary care resources to those seeking services through an emergency department.