北京市属医院急诊科拥堵的原因研究

目的 急诊室人满为患已是很多国家面临的严重问题.评估北京各大医院急诊科是否存在拥堵及拥堵的原因.方法 采用多中心横断面研究.研究对象包括2012年至2013年北京市医院管理局所属18家市级医院的急诊科来诊患者,对患者的特点及治疗情况进行了分析.结果 2012年度急诊抢救病例仅占当年急诊就诊人数的4.6％ (71 224/1 554 387)而2013年度略有上升为5.5％(88 190/1 615 571).2012及2013年度急诊留观患者总数分别为185 277和211 900,增涨14.4％(P＜0.01),而急诊住院的患者总数仅占急诊就诊人数的2.97％及2.89％,这些患者从急诊收住院的平均等候时间为37.1 h,而急诊平均留观时间为4.9d及5.4d.上呼吸道感染是急诊就诊病种的第一位,卧床合并肺炎是留观患者的第一位病因.结论 目前的急诊科实际上承担了24h门诊的任务,急诊科人满为患.其主要原因是大量非急诊患者到急诊就诊,急诊患者住院困难.疾病终末期及多器官功能衰竭患者由于缺乏出口而滞留于急诊室.

Causes of access block and Emergency department overcrowding in Beijing: a two year study

Objective To study the causes of emergency department (ED) overcrowding and access block in Beijing.Methods This was a multi-center cross sectional study.The studied cohort of patients included all ED visiting patients from 18 municipal teaching hospital EDs in Beijing from 2012 to 2013.Patient' s characteristics and medical care settings were analyzed.Results The urgent care cases accounted for only 4.6 ％ (71 224/1 554 387) of the emergency annual visits in 2012 and 5.5 ％ (88 190/1 615 571) in 2013.The total number of observation patients in EDs was 185 277 and 211 900 in 2012 and 2013 respectively,with an increase of 14.4 ％ (P ＜ 0.01).The total ED-admission inpatients only accounted for 2.97％ and 2.89 ％ of total annual visits in 2012 and 2013 respectively.The average time of ED-admission took 37.1 hours and 36.2 hours in 2012 and 2013 respectively.The average time of ED stay for observation was 4.9 days and 5.4 days in 2012 and 2013 respectively.Upper respiratory tract infection was the leading illness in annual visits.The leading cause of ED stay for observation was bedridden with pneumonia.Conclusions The ED settings in Beijing are different from other countries.The EDs actually assume the task of the clinic and ED service for 24 hours thereby made EDs terribly overcrowded.The main causes are large number of non-emergency patients visiting the ED and patients in the ED are difficulty to be hospitalized.Patients with end-stage disease and multiple organ failure stayed in the ED due to nursing home shortage.