院前急救医疗服务的资源利用情况分析

Analysis of resources utilization of pre-hospital emergency medical services

目的探讨某三甲医院院前急救医疗服务资源利用的现状及影响因素。方法依托急诊预检分诊系统,记录2019年1月至2019年12月某三甲综合医院急诊就诊患者的就诊方式、一般资料及疾病特征,根据是否使用院前急救医疗服务以及是否属于急重症呼叫将患者分为急重症使用、急重症未使用、非急重症使用和非急重症未使用四组,比较四组患者的一般资料、疾病特点是否存在差异,探索院前急救医疗服务使用欠合理的影响因素。结果共纳入急诊患者81958例,8771例(10.7%)使用了院前急救服务,其中符合急重症标准的仅3706例(42.25%),而非急重症占57.75%;在未使用院前急救医疗服务的患者中,仍有12386例(16.92%)急重症患者。多因素回归分析中发现,在急重症患者中,年龄大(OR值1.131,95%CI 1.069~1.196,P<0.001)、症状为急性胸痛(OR值1.734,95%CI 1.395~2.157,P<0.001)和头痛(OR值3.158,95%CI 1.433~6.959,P=0.004)是选择不使用院前急救医疗服务的独立因素。在非急重症中,男性(OR值为1.330,95%CI 1.250~1.414,P<0.001),就诊外科(OR值1.382,95%CI为1.210~1.579,P<0.001)和神经外科(OR值2.058,95%CI 1.663~2.547,P<0.001),区域为非本区,症状为外伤(OR值2.269,95%CI 1.920~2.682,P<0.001)、肢体麻木或无力(OR值1.815,95%CI 1.651~1.996,P<0.001)、发热(OR值2.696,95%CI 2.156~3.370,P<0.001),夜班就诊是非急重症使用院前急救医疗服务的独立因素。结论院前急救医疗服务资源利用存在明显的不合理现象,主要表现在过半数的急危重症患者没有选择院前急救医疗服务,而非急重症患者使用院前急救医疗服务数量可观。居民对急危重症和院前急救医疗服务的选择意识明显不足,有必要进一步加强宣教,并借助远程医疗系统建立和实施统一的院前急救医疗服务提供标准,促进急救资源的合理利用。

Objective To explore the status and influencing factors of pre-hospital emergency medical service resources utilization in a grade A tertiary hospital.Methods The mode of arrival,general information and disease characteristics of emergency department patients in a grade A tertiary hospital from January to December 2019 were recorded based on emergency pre-examination and triage system.Patients were divided into four groups according to whether they used pre-hospital emergency sevices and whether they belonged to the critical call.The differences in general information and disease characteristics of patients in the four groups were compared,and the influencing factors of the unreasonable use of pre-hospital emergency sevices were explored.Results A total of 81958 patients were included,of which 8771 patients(10.7%)used pre-hospital emergency services,3706 patients(42.25%)were critical cases and non-critical cases accounted for 57.75%.Among the patients who did not use pre-hospital emergency sevices,there were still 12386 patients(16.92%)with critical illness.Multivariate regression analysis showed that in the critical patients,advanced age(OR 1.131,95%CI 1.069-1.196,P<0.001),acute chest pain(OR 1.734,95%CI 1.395-2.157,P<0.001),headache(OR 3.158,95%CI 1.433-6.959,P=0.004)were independent factors in choosing not to use pre-hospital emergency care.In non-critical patients,men(OR 1.330,95%CI 1.250-1.414,P<0.001),surgical patients(OR 1.382,95%CI 1.210-1.579,P<0.001),the patients in neurosurgery department(OR 2.058,95%CI 1.663-2.547,P<0.001),the patients not in this region,the patients with the symptoms of trauma(OR 2.269,95%CI 1.920-2.682,P<0.001),limb numbness or weakness(OR 1.815,95%CI 1.651-1.996,P<0.001),fever(OR 2.696,95%CI 2.156-3.370,P<0.001),night shift visit were independent factors for the use of pre-hospital emergency care in non-critical patients.Conclusions There is an obvious unreasonable phenomenon in the utilization of pre-hospital emergency service resources,which is mainly reflected in the fact that more than half of the critical patients did not choose pre-hospital services,while a considerable number of non-critical patients used pre-hospital emergency services.It is necessary to further strengthen publicity and education,and establish and implement unified standards for the provision of pre-hospital emergency services with the help of telemedicine system,so as to promote the rational use of emergency resources.