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.

Cox regression analysis of 6246 critically ill patients with prolonged stay in emergency room

Objective To explore factors associated with prolonged emergency room (ER) stay of critically ill patients admitted so as to accelerate throughput of emergency patients.Methods Data of critically ill patients admitted into the emergency room of a tertiary teaching hospital in 2010 were retrospectively studied.Stepwise Cox regression analysis was used to determine factors likely associated with prolonged stay in ER.Results ( 1 ) A total of 6246 critical illnesses were admitted into emergency room,the ER length of stay [M (Qr)] was 11 h (3 ～23 h).Of them,56.6％ patients stayed in ER more than 6 h and 21.6％ over 24 h.(2) Univariate analysis showed the major factors contributing to prolonged stay in ER were insufficient inpatient bed capacity,followed by poor family finances,complicated diseases needed care from multiple departments,emergency operation,lack of specialty wards,lack of department bearing main responsibility of critical care,age,gender and arrival time to ER.(3) Multivariate analysis showed that the main factors contributing to prolonged stay were insufficient inpatient beds,poor family finances,complicated diseases needed treatment from multiple departments,emergency operation,lack of specialty wards,lack of department bearing main responsibility of treatment,gender and arrival time to ER.Age was not an independent factor.Conclusions Plenty of critically ill patients admitted to this hospital had prolonged stay in emergency room with variety of factors.The possible factors contributing to this were insufficient inpatient bed capacity,poor family finances and complicated diseases needed care from multiple departments,and this investigation deserves a further study.