急诊室患者滞留的影响因素

急诊室患者滞留时间是指患者从预检分诊开始到离开急诊室的时间段,包括急诊预检分诊时间(通常很短,可忽略不计)、抢救治疗时间、初步抢救后决定住院到实际离开急诊室的时间[1].患者的不合理滞留会带来严重的后果,包括增加患者的住院时间、医疗费用、不良事件发生率和病死率.所以,急诊室患者滞留时间是衡量急诊患者处置质量和效率的一个重要指标,被广泛运用于严重创伤、危急重症患者的急诊疾病处置中.     

综合性医院急诊抢救患者构成和分流的状况分析

目的 调查一家综合性三甲医院急诊抢救患者的数量、科室构成和分流去向,为进一步改善医院急诊医疗服务质量的决策提供依据.方法 使用自主开发的急诊预检分诊登记数据库,回顾性调查分析一家综合性三甲医院2010年全年急诊抢救患者的相关信息,包括抢救患者数、急诊室滞留时间、科室构成、分流去向和抢救床利用情况.结果 ①医院全年急诊抢救患者7966例,占急诊总数的10.1%.急诊抢救室床位利用率为(90.1±9.1)%,单床周转(1.2±0.1)次/d,患者在抢救室的滞留时间为(18±44)h.②急诊抢救患者数前四位的科室依次为神经外科、急诊内科、神经内科和急诊科,占抢救总数的79.1%.③抢救患者直接住院4983例(62.6%),急诊手术后住院1263例(15.9%),好转直接出院545例(6.8%),死亡91例(1.1%),自动出院1084例(13.6%).各科抢救患者的去向存在差异.结论 该家三甲医院急诊抢救患者的比例比较高,抢救室工作处于高负荷状态;抢救患者主要集中在四个科室,且大部分患者需要收住院.医院有必要根据急诊抢救室的工作状况,相应地优化医疗资源的配置和改善服务流程.     

综合性医院急诊患者流行病学研究

目的研究综合性医院急诊患者流行病学特点。方法采用前瞻性资料收集的方法,对2003年度到本院急诊患者的性别、年龄、就诊时间、职业、就诊方式、急诊诊断或主诉、去向等项目进行调查统计分析。结果共收到57636份调查表,占全年急诊实际患者的98.06%。男女比例为1.27:1。高发年龄组为0～9岁、20～29岁和30～39岁3个组。4、5、6月份就诊患者最多。每天18:00～23:00为来诊高峰时间。前三位职业依次为儿童学生、干部职员、工人。利用出租车或小车来诊者占44.46%,公共汽车占16.12%,救护车占11.53%。收入院率17.73%。报告了除创伤、发热外20种急诊诊断或主诉。结论①要特别重视男性健康和安全防范教育,提高救治水平对人类健康和学科建设有重大意义;②急诊科是应对突发公共事件重要的部门,要有应急预案;③根据急诊患者就诊密度,科学合理地安排工作;④急诊服务半径相对较小,急诊患者是住院患者的主要来源;⑤院前急救急诊室急救急诊或中心ICU一体化模式是符合急诊学科发展的模式;⑥常见诊断或主诉,对指导急诊专业人员培训有意义。     

缩短急诊患者滞留时间的方法实践

目的探讨缩短急诊患者滞留时间的有效方法。方法分析急诊患者滞留的原因:急诊量大;急诊人力资源配置不足;急诊就诊与门诊就诊程序相同,未能进行急诊分诊流程进行快速就诊;专科入院程序相对复杂等。针对原因实施减少急诊患者滞留时间的流程改造:制定并落实急诊分诊、绿色通道制度;改善就诊秩序;优化人力资源管理,增配医护值班人员及转运人员;制定标准化流程,完善急诊服务流程;加强医患沟通;建立急诊滞留预警机制。比较改进措施前后急诊患者的滞留时间及满意度。结果采取有效措施后,急诊患者的滞留时间由原来的(40.1±5.2)min缩短至(24.2±5.3)min(t=3.257,P=0.001);患者与家属满意度由原来的87.7%上升为94.2%,患者与家属满意度明显升高(χ2=5.012,P=0.002)。结论通过实施流程改造、优化就诊程序、改善就诊环境、改善人力资源等措施,及时合理地分流急诊患者,缩短了急诊患者滞留时间,提高了患者与家属的满意度。     

改良全程急诊护理在急性脑出血患者抢救中的应用研究

目的分析改良全程急诊护理在急性脑出血患者抢救中对急救时间及护理满意度的影响。方法选取2016年1~12月收治的急性脑出血患者80例,按照入院先后顺序分为观察组与对照组,每组各40例。对照组行常规护理,观察组行改良全程急诊护理,对比两组急救时间、急诊反应时间、死亡率、住院时间及对护理总满意度情况。结果观察组分诊评估时间、静脉用药时间、头颅CT时间和急救总时间短于对照组,差异有统计学意义(P0.05);观察组急诊反应时间、住院时间短于对照组,差异有统计学意义(P0.05);观察组死亡率低于对照组,差异有统计学意义(P0.05);观察组护理总满意度高于对照组,差异有统计学意义(P0.05)。结论改良全程急诊护理运用于急性脑出血患者抢救中可缩短急救时间,减少急诊反应时间和住院时间,降低死亡率,提升护理总满意度,值得推广。     

对急诊科护士心理健康状况的调查及对策的研究

随着社会的发展,急救医学与急救护理学发展的速度日新月异,急救技术不断精益求精,急诊工作愈发重要。由于急救对象多为病情危、急、重者,且病人家属求医心切,要求很高。由于急诊科担负着院外急救、抢险救灾、危重病救护等工作,每一项工作都时间紧急,责任重大。急诊科护士长期在     

提高急诊护士急救能力与降低急诊抢救患者死亡率的相关性分析

目的 探讨提高急诊护士抢救能力与降低急诊抢救患者死亡率的相关性.方法 对我科室2013年和2014年急诊抢救的重点病种患者进行统计,与我院于2012年2月启动创建三级甲等医院以来,对我科急诊护士进行急救能力培训考核后的相关性进行分析.结果 培训考核后的急诊护士急救能力有较大提高,2014年与2013年相比急诊抢救重点病种人数升高,死亡患者人数下降.结论 提高急诊护士的急救综合能力,能降低急诊抢救患者的死亡率.     

成批伤员的急诊抢救与组织管理

急诊是医疗工作的第一线,其抢救质量的高低集中反应了医疗技术水平,直接体现医院的管理水平和医务人员的基本素质,是医院全面管理的缩影。能否达到使垂危病员经抢救、治疗后不成为社会的负担这一质量要求,要点是在于现场急救、急诊及时与恰当的处     

服毒自杀急诊患者的抢救及护理

急诊突出一个“急”字，接诊护士，必须不失时机地对病情做出快速准确的估计，而服毒病人来院求治。无论在心理上还是生命质量上，患者及家属求生欲望更强，所以急诊科护士必须配合医生做好有效及时地抢救。而洗胃是减少毒物吸收提高生命质量的重要环节，是实施急救措施成功的关键，护士能熟练科学地掌握洗胃技术，密切观察洗胃反应，针对自杀患者的特点做好身心护理是极为必要的，现笔者将护理体会总结如下。     

1例心脏穿透伤急诊室剖胸患者的急救护理

穿透性心脏损伤是胸外科的急危重症,和平时期最常见的致伤原因为刀刺伤。快速诊断和急救对挽救病人的生命有重要意义。我科2002年6月为1例处于濒死状态的失血休克型心脏刀刺伤患者在急诊室行剖胸探查手术,成功地挽救了患者的生命。现将急救护理体会报道如下。     

急诊室危重患者滞留时间影响因素Logistic回归分析

目的 探索影响急诊抢救室危重患者滞留时间的相关因素,为急诊管理者制定相关措施提供依据.方法 回顾性分析一家综合性医院2010年1月至2011年6月急诊抢救室危重患者的信息,通过二分类Logistic回归分析滞留时间的影响因素,并进一步比较主要影响因素特征.结果(1)2010年1月至2011年6月急诊抢救室共有危重患者11 468例,滞留的中位数时间为11h,滞留时间＞6h的有6 525例,占56.9％.(2)影响急诊危重患者滞留时间超过6h的主要因素有主诊科室、绿色通道、就诊时间段.其次为收入ICU、交通事故、120送入、初步诊断个数、离开抢救室去向、性别、节假日就诊、就诊月份.而患者的年龄、职业、户籍不是影响患者滞留时间超过6h的因素.结论 该家医院危重患者在抢救室滞留的时间偏长,主要受主诊科室、绿色通道、就诊时间段等因素影响,值得重视并进一步研究.     

Headache patients in the emergency department of a Greek tertiary care hospital

The aim of this study was to record the demographic and epidemiological data on adult patients with headache who attend the emergency department (ED) and the diagnoses that made by the neurologists in the ED of a tertiary care hospital in metropolitan Thessaloniki (Greece). In an open prospective study, demographic and epidemiological data were collected on all patients who reported headache (as chief complaint or not) and presented to the ED of Papageorgiou Hospital between August 2007 and July 2008. Headache patients accounted for 1.3% of all ED patients and for 15.5% of patients primarily referred to the ED neurologist. Tension type headache was the most frequent diagnosis, followed by secondary headaches and migraine. The large number of patients without final ED diagnosis and ward admission for further evaluation sheds a light on the immense workload of Greek ED physicians. Furthermore, we found evidence for the misuse of Emergency Medical Services by chronic headache patients. These findings indicate shortcomings in the pre-hospital (primary care) management of headache patients in the Greek National Health System to an extent unreported so far.     

急诊科拥挤度变化规律研究:昼夜节律和节假日效应

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.     

Demand for hospital emergency departments: a conceptual understanding

BACKGROUND:

Emergency departments (EDs) are critical to the management of acute illness and injury, and the provision of health system access. However, EDs have become increasingly congested due to increased demand, increased complexity of care and blocked access to ongoing care (access block). Congestion has clinical and organisational implications. This paper aims to describe the factors that appear to influence demand for ED services, and their interrelationships as the basis for further research into the role of private hospital EDs.

DATA SOURCES:

Multiple databases (PubMed, ProQuest, Academic Search Elite and Science Direct) and relevant journals were searched using terms related to EDs and emergency health needs. Literature pertaining to emergency department utilisation worldwide was identified, and articles selected for further examination on the basis of their relevance and significance to ED demand.

RESULTS:

Factors influencing ED demand can be categorized into those describing the health needs of the patients, those predisposing a patient to seeking help, and those relating to policy factors such as provision of services and insurance status. This paper describes the factors influencing ED presentations, and proposes a novel conceptual map of their interrelationship.

CONCLUSION:

This review has explored the factors contributing to the growing demand for ED care, the influence these factors have on ED demand, and their interrelationships depicted in the conceptual model.KEY WORDS: Emergency department, Demand, Crowding, Risk factors, Emergency services, Emergency medicine, Emergency room     

Primary contact physiotherapy in emergency departments can reduce length of stay for patients with peripheral musculoskeletal injuries compared with secondary contact physiotherapy: a prospective non-randomised controlled trial

Objective

To evaluate if direct physiotherapy assessment and management of patients presenting to emergency departments with musculoskeletal injuries (primary contact physiotherapy) results in reduced length of stay without any increase in adverse effects compared with secondary contact physiotherapy, where patients are seen by a physiotherapist after initial assessment by a doctor.

Design

Prospective non-randomised controlled trial.

Setting

Three metropolitan emergency departments.

Participants

Adults (n = 315) presenting to emergency departments with peripheral musculoskeletal injuries were allocated to primary or secondary contact physiotherapy; 306 participants completed the study. Patients with serious pathology, open fractures and spinal pain were excluded.

Intervention

A single episode of physiotherapy.

Main outcome measures

Primary outcome measures were patient length of stay, waiting time and treatment time. Secondary outcome measures were re-presentations to the emergency department, imaging referrals, patient satisfaction and emergency department staff acceptance.

Results

Primary contact physiotherapy resulted in a reduction in length of stay of 59.5 minutes [95% confidence interval (CI) 38.4 to 80.6] compared with secondary contact physiotherapy, with a reduced waiting time of 25.0 minutes (95%CI 12.1 to 38.0) and a reduced treatment time of 34.9 minutes (95%CI 16.2 to 53.6). There were no differences between the groups in imaging referrals or re-presentations. Patients strongly agreed (≥82%) that they were satisfied with their management, and 96% of emergency department staff agreed that primary contact physiotherapists had appropriate skills and knowledge to provide emergency care.

Conclusion

Experienced musculoskeletal physiotherapists working in emergency departments can be the first point of contact for patients with simple, semi-urgent and non-urgent peripheral musculoskeletal injuries, resulting in decreased waiting times and length of stay for patients without any adverse effects.     

6246例急诊住院危重患者抢救室滞留的Cox回归分析

目的 了解收住院的危重急诊患者在抢救室滞留的影响因素,为加快患者的分流提供依据.方法 回顾性分析一家综合性医院2010年经急诊抢救室住院的危重患者的信息,通过Cox回归分析法研究影响患者在抢救室滞留的危险因素.结果 (1)全年经急诊抢救室住院的危重患者6246例,抢救室滞留的时间(中位数、四分位间距)为11 h(3～23 h),有56.6％的患者滞留时间超过6h,21.6％的患者滞留时间超过24h.(2)单因素分析显示影响患者滞留的最重要因素是专科病房的床位状况,其次为患者的医疗费用支持状况、病情是否涉及个多科室、是否急诊手术、收住病房的类型、主诊科室、年龄、性别和就诊时间段.(3)Cox多因素回归分析提示,最主要的影响因素为专科病房的床位状况、患者的医疗费用支持状况和病情是否涉及多科室;其次为是否急诊手术、收住病房的类型、主诊科室、性别和就诊时间段,年龄不影响患者的滞留时间.结论 该家医院经急诊收住院的危重患者在抢救室滞留时间偏长,主要的影响因素是专科病房不能及时提供床位,病情涉及多科室而偏复杂,患者的医疗费用支付困难,值得进一步的研究.