综合性三甲医院急诊室抢救患者滞留状况的研究

Study on prolonged length of stay in emergency room for patients in a major tertiary hospital

目的调查某家综合性三甲医院抢救患者在急诊室的滞留状况,为进一步加快急诊抢救患者的分流,提高急诊服务质量提供依据。方法使用急诊预检分诊数据库,回顾性调查分析某综合性三甲医院2010年全年急诊室抢救患者的相关信息,包括不同月份、不同科室、不同去向抢救患者的滞留时间及可能的原因。结果①该院全年7966例抢救患者在急诊室滞留的时间为0.5～2998 h,中位数10 h(四分位数3～23 h);②不同月份抢救患者的滞留时间比较差异有统计学意义(χ2=22.869,P=0.018),其中2月份最短,5月份最长;③患者对急诊抢救室床位占用时间最长的4个科室依次为急诊内科、神经外科、神经内科和急诊科,合计达91.8%的总床位占用时间。患者在急诊抢救室滞留时间最长的4位科室依次为急诊内科、神经内科、神经外科和胸外科;④不同去向的抢救患者滞留时间比较差异有统计学意义(χ2=731.471,P<0.0001),其中以直接住院和自动出院患者的滞留时间最长;⑤滞留时间24 h以上的抢救患者中,83.4%与相应的专科病房无床有关。结论该家医院急诊室抢救患者的滞留状况比较严重,其中急诊内科、神经内科、神经外科3个科室尤为严重,主要与相应专科的病房床位供应不足有关,医院有必要采取相应的对策。

Objective To investigate the prolonged length of stay （LOS） in emergency room for patients in a major tertiary hospital to solve the problem of overcrowding in emergency room and promote the quality of emergency service. Methods All patients presented to emergency room in 2010 were retrospectively analyzed using the emergency triage database. LOS in emergency room was compared among patients entering emergency room in different months, treated by different departments and with different destinations of shunt. Probable causes of prolonged LOS were also analyzed. Results 7966 critically ill patients were treated in the emergency room in 2010. The LOS was 0.5 -2998 h, with a median time of 10 h （IQR 3 - 23 h）. There were significant difference in the LOS among different months （x^2 = 22. 869, P = 0. 018）. The shortest LOS was found in February, and the longest in May. Patients in department of emergency medicine, neurosurgery department, neurology department and thoracic surgery department occupied beds in the emergency room in 91.8% of the time. Patients in department of emergency medicine had the longest LOS, followed by neurology department, neurosurgery department and thoracic surgery department. There was significant difference in LOS among patients with different destinations of shunt （ x^2 =731. 471, P 〈 0. 0001 ）, among which patients admitted directly from emergency room and patients discharged from hospital automatically stayed in emergency room longer than others. Almost 83.4% patients whose LOS in emergency room exceeded 24 h were transferred into wards timely due to lack of inpatient beds. Conclusions The prolonged LOS in emergency room is severe in this hospital. Overcrowding and prolonged LOS emerge in department of emergency medicine, neurology department and thoracic surgery department due to insufficient inpatient beds, which should arouse more attention of hospital administrators.