老年急诊患者滞留原因分析及对策探讨

Analysis of elderly people detention in emergency department and management

目的 在全面了解老年患者急诊就诊情况的基础上,分析老年患者滞留急诊的原因,提出有效的应对策略.方法 回顾性分析一家大型综合性医院2011年10月1日至2012年9月30日急诊老年患者的就诊信息,对所诊科室人数和留观时间进行描述性统计分析,运用多元回归方法分析老年滞留影响因素.结果 老年留观患者年龄主要集中在80～89岁,留观科室以急诊内科为主,滞留患者占76.6％.方差分析显示不同科室老年急诊患者留观时间长短有统计学差异（P＜0.05）.利用多元回归分析老年滞留患者的年龄和主诊科室是滞留急诊时间长短的影响因素.结论 及时分流急诊老年滞留患者对缓解急诊室过度拥挤具有重要的作用,协调各专科病房之间的关系,疏通住院渠道,使急诊观察室老年患者滞留问题得到解决,将更好保障老年患者权益及护理安全.

Objective This study was to investigate the causes of emergency department （ED） crowding in order to provide better solution to crowding.. Methods A retrospective study was conducted on the person-based ED visit data in a tertiary teaching hospital from October 2011 to September 2012. The multiple logistic regression model was used to assess the factors that account for ED crowding. The number of patients according to different departments and the length of stay were further analyzed by quartiles. Results Multivariate regression analysis showed ED crowding was significantly correlated with the quantity of visits a day, the number of patients who need to stay per day and who stay more than 3 days. The quartile analysis demonstrated significant difference between the various departments on the basis of the number of patients and the length of stay. Conclusions The improvement of diversion of patients has an important role to relieve the ED crowding. The co-ordination of the relationship between a range of departments in hospital and reducing access block as well as prompt emergency care for patients boarding in the hallway of ED are the principle steps to evade the dilemma of ED.