Emergency Department Crowding: Community Determinants and Patient Outcomes

急诊科拥挤：社区决定因素和患者结果

• 批准号: 7858223
• 负责人: Benjamin C Sun
• 金额: $ 4.63万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2011-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7858223
• 关键词: Emergency; Department; Crowding; Community; Determinants

DESCRIPTION (provided by the applicant): Emergency department (ED) crowding has strained the acute care system to its breaking point. Two of the most visible symptoms of ED crowding, ambulance diversion and 'left before being seen' visit rates, have dramatically increased over time and are now routine in many urban centers. ED crowding causes delays in evaluation and treatment, which in turn may contribute to adverse outcomes. Consequently, the American College of Emergency Physicians has identified ED crowding as one of the top problems threatening the safety and quality of emergency care. However, policymakers and health system leaders have failed to address emergency department crowding as a top public health priority. The primary reason for inaction is the paucity of data on community disparities in ED crowding and the impact of ED crowding on patient outcomes. Without such evidence, policymakers are unlikely to commit substantial resources to address root causes of ED crowding. In order to assess patterns and outcomes of ED crowding, we propose a retrospective cohort study of all 2007 ED visits to non-federal, California hospitals. This analysis will include 8.8 million discharges and 1.5 million hospitalizations from 342 California EDs. We will use daily ambulance diversion hours and 'left before being seen' (LBBS) visit rates as measures of ED crowding. This study has the following Specific Aims: 1. Identify community level predictors of emergency department crowding. 2. Assess the relationship between emergency department crowding and 7-day bounce-back hospitalizations after emergency department discharge. 3. Assess the relationship between emergency department crowding and inpatient outcomes, including death, length-of-stay, and costs. California accounts for nearly 10% of all ED visits in the United States and represents a diversity of patient populations and hospital systems. Therefore, the proposed study will provide generalizable insights into this health policy crisis.

描述（由申请人提供）：急诊科 (ED) 的拥挤状况已使急症护理系统不堪重负。急诊室拥挤的两个最明显的症状是救护车分流和“未见人就离开”就诊率，随着时间的推移急剧增加，现在在许多城市中心已成为常态。急诊室拥挤会导致评估和治疗的延误，进而可能导致不良后果。因此，美国急诊医师学会将急诊科拥挤视为威胁急诊护理安全和质量的首要问题之一。 然而，政策制定者和卫生系统领导人未能将急诊科拥挤问题作为公共卫生的首要任务。不采取行动的主要原因是缺乏关于急诊室拥挤的社区差异以及急诊室拥挤对患者预后影响的数据。如果没有这些证据，决策者就不可能投入大量资源来解决急诊室拥挤的根本原因。 为了评估急诊室拥挤的模式和结果，我们建议对 2007 年加州非联邦医院的所有急诊室就诊进行回顾性队列研究。该分析将包括 342 家加州急诊室的 880 万人出院病例和 150 万人住院病例。我们将使用每日救护车分流时间和“就诊前离开”(LBBS) 就诊率作为急诊室拥挤程度的衡量标准。本研究有以下具体目标： 1. 确定社区层面急诊科拥挤的预测因素。 2. 评估急诊科拥挤与急诊科出院后 7 天恢复住院之间的关系。 3. 评估急诊科拥挤与住院结果（包括死亡、住院时间和费用）之间的关系。 加利福尼亚州的急诊就诊量占美国所有急诊就诊人数的近 10%，并且患者群体和医院系统具有多样性。因此，拟议的研究将为这场卫生政策危机提供普遍的见解。