我国三级医院急诊病人激增应对方式调查

Investigation on coping strategies for the increases of patients from emergency department in tertiary hospitals in China

目的:了解我国三级医院急诊病人激增应对方式。方法:于2023年1月—3月选取我国54所三级医院急诊科作为研究对象,其中,东部地区26所(48.1%),中部地区10所(18.5%),西部地区18所(33.3%)。采用自行编制的中国不同地区医院急诊病人激增应对方式调查问卷进行调查。结果:三级医院急诊病人激增后日均急诊量增幅达87.5%,急诊日均候诊时间整体延长(Z=-5.560,P<0.001),东部地区三级医院急诊病人激增后72 h出抢救室病人比例较激增前下降(P<0.05)。面对急诊病人激增,各三级医院采取的应对措施包括增加急诊床位数和出诊医生诊位、增设专门收治新型冠状病毒感染病人的病房、增加重点设备投入、调配医护人员支援急诊等。东部地区三级医院急诊候诊时间变化率与医患比变化率(r=-0.418,P=0.034)、护患比变化率(r=-0.469,P=0.016)、互联网诊疗变化率(r=-0.684,P=0.020)均呈负相关,东部地区三级医院抢救室滞留时间变化率与护患比变化率呈负相关(r=-0.422,P=0.032),中西部地区三级医院抢救室滞留时间变化率与留观室床位变化率呈正相关(r=0.405,P=0.036)。结论:急诊科应不断优化人力、床位、仪器设备等医疗资源配置,探索急危重症病人“互联网+”新模式,进一步提升重大传染病的应对能力。

Objective:To understand coping strategies for the increases of patients from emergency department in tertiary hospitals in China.Methods:Emergency departments from 54 tertiary hospitals in China were selected as the research subjects From January to March 2023.Among them,26 hospitals(48.1%)in the eastern region,10 hospitals(18.5%)in the central region,and 18 hospitals(33.3%)in the western region.A survey was conducted by a self-designed questionnaire on coping strategies for the increases of patients from emergency department in hospitals in different regions of China.Results:After increasing of patients from emergency department in tertiary hospitals,the daily average emergency volume increased by 87.5%,and the overall waiting time for emergency treatment was extended(Z=-5.560,P<0.001).The proportion of patients leaving the emergency room 72 hours after increased of patients from emergency department in tertiary hospitals in the eastern region decreased compared to before(P<0.05).In the context of increases of patients from emergency department,the response measures taken by the tertiary hospitals included increasing the number of emergency beds and the number of visiting doctors,adding wards dedicated to the treatment of patients with COVID-19,increasing investments in important equipment,and deploying medical staff to support emergency and so on.The change rate of emergency waiting time in tertiary hospitals in eastern region were negatively correlated with the change rate of doctor-patient ratio(r=-0.418,P=0.034),the change rate of nurse-patient ratio(r=-0.469,P=0.016),and the change rate of Internet diagnosis and treatment(r=-0.684,P=0.020).The change rate of retention time in emergency rooms in tertiary hospitals in eastern region was negatively correlated with the change rate of nurse-patient ratio(r=-0.422,P=0.032).The change rate of retention time in emergency rooms in tertiary hospitals in central and western regions was positively correlated with the change rate of observation room beds(r=0.405,P=0.036).Conclusions:The emergency department should constantly optimize the allocation of medical resources such as manpower,beds,instruments and equipments,it also should explore the new"Internet+"model for critical patients,and further improve the ability to cope with major infectious diseases.