急诊观察室患者滞留原因分析及对策

  目的  通过分析急诊临时观察室患者滞留时间的相关影响因素，为解决急诊室拥挤问题提供实践依据。
  方法  收集2019年1—12月上海市某三级甲等医院急诊临时观察室所有出观患者基本信息，根据留观时间不同，分为两组:A组患者留观时间≤ 7 d，B组患者留观时间> 7 d；调查两组患者年龄、性别、来源、疾病分类、医疗费用支付方式、转归等情况；采用二分类多因素logistic回归分析患者留观时间的影响因素，总结留观患者长期滞留的原因。
  结果  研究期间，出观患者共2 211例，年龄10~101岁，平均（67.81±18.87）岁，留观时间1~2 002 d，平均M（P₂₅，P₇₅）为2.5（1，9）d，急诊临观滞留时间≥ 72 h共计1 076例（占48.67%）。≥ 60岁患者平均留观时间多于 < 60岁患者，差异有统计学意义（P < 0.01）；出观患者中，病情缓解、出观离院1 183例，收入病房806例，转回抢救室97例，死亡125例。不同出观结局患者留观时间不同，收入病房患者留观时间最短，死亡患者留观时间最长（P < 0.01）。A组出观患者以神经系统疾病最多，B组出观患者以呼吸系统疾病最多。多因素logistic回归分析结果显示:患者年龄每增加一岁，留观时间 > 7 d的可能性是原来的1.293倍；以死亡患者为对照，缓解出院患者留观时间 > 7 d的可能性是其0.301倍，收入病房患者留观时间 > 7 d的可能性是其0.026倍，转送抢救室患者留观时间 > 7 d的可能性是其0.183倍。以来自诊室为对照，来自抢救室的患者留观时间 > 7 d的可能性是前者的0.754倍。
  结论  急诊留观患者滞留时间与患者年龄、疾病危重性、分类和临床预后密切相关。急诊留观患者滞留时间过长可导致急诊室拥挤，影响急诊资源的有效利用，应通过调整国家卫生政策、加强医院管理和服务能力，合理配置医疗资源，引导患者理性就医，改善公立三甲医院急诊室拥挤现象。

Analysis of reason for longer time stay of patients in emergency observation ward

  Objective  To analyze the influencing factors for longer time stay of patients in emergency observation ward, and to provide practical basis for solving emergency crowding.  Methods  The information of all patients was collected and analyzed in the emergency observation ward during January to December 2019, in a hospital with a class Ⅲ grade in Shanghai. According to the number of stay days, patients were divided into two groups: ≤ 7 days in group A, and > 7 days in group B. The difference of age, gender, source, disease classification, medical expenses payment method, outcome and other conditions of patients in these two groups were compared, and the influencing factors of patients' stay time were analyzed by binary multivariate logistic regression, and the causes of long-term stay were summarized.  Results  During the study period, 2 211 patients used the emergency observation ward. Their age ranged from 10 to 101 years old with an average age of (67.81 ±18.87) years old. The stay time in emergency observation ward varied from 1 to 2002 days, with the M(P₂₅, P₇₅) as 2.5(1, 9)days. Totally 1 076 cases(48.67%) stayed in emergency observation ward for more than 72 h. The average stay time of patients over 60 years old was more than that of patients under 60 years old, and the difference was statistically significant (P < 0.01). The outcome survey showed that 1 183 cases were in remission and out of hospital, 806 cases were admitted to the ward, 97 cases were transferred to the rescue room, and 125 cases died. The stay time of patients with different outcome was different, shortest for the patients admitted to ward and longest for the death cases (P < 0.01). It was noted that the largest number of neurological patients in group A and the largest number of respiratory patients in group B were in remission and out of hospital. Multivariate logistic regression analysis showed that the probability of staying for more than 7 days increased by 1.293 times for each one year of patients' age increase. Compared with death cases, the possibility of staying for more than 7 days of the patients being discharged, admitted to ward and being transferred to the rescue room was 0.301 times, 0.026 times and 0.183 times, respectively. Taking the patients in the consulting room as the control, the possibility of patients from the rescue room to stay for more than 7 days was 0.754 times.  Conclusion  The time of patients' stay in emergency observation ward is closely related to age, disease type and clinical prognosis. The longer stay time of emergency patients may lead to emergency crowding. It is necessary to adjust the national health policy, strengthen the hospital management and service ability, reasonably allocate medical resources, and guide patients to seek medical treatment rationally, so as to improve the emergency room crowding phenomenon in public hospitals.