急诊科拥挤成因、后果及缓解方案的研究进展
摘要
<正>急诊科拥挤已是目前国内外急诊科较为普遍的现象,并逐渐成为一个世界各国关注的公共卫生问题[1]。急诊科拥挤的发生涉及到多个层面,带来了一系列严重的不良后果[2-3]。近年来,急诊科拥挤现象引起了国内外医学研究者的高度重视,成为急诊医学研究的热点[4]。本文就近几年国内外提出的有关急诊科拥挤现象成因、后果和缓解方案进行综述,以期为缓解我国急诊科拥挤提供参考和帮助。1急诊科拥挤的相关定义
引文
[1]徐腾达,马遂,于学忠.急诊科拥挤现象的研究[J].中华急诊医学杂志,2008,17(11):1221-1223.
[2]张晖,王仲,徐腾达,等.急诊科拥挤现象成因分析[J].中华医院管理杂志,2013,29(3):235-238.
[3]于学忠,徐腾达.急诊系统会崩溃吗[J].中华急诊医学杂志,2011,20(10):1013.
[4]徐腾达,马遂,于学忠.急诊医学研究新视角[J].中国急救医学,2010,(3):194-196.
[5]American College of Emergency Physicians.Crowding[J].Ann Emerg Med,2006,47(6):585.
[6]Forero R,McCarthy S,Hillman K.Access block and emergency department overcrowding[J].Crit Care,2011,15(2):216.
[7]Asplin BR,Magid DJ,Rhodes KV,et al.A conceptual model of emergency department crowding[J].Ann Emerg Med,2003,42(2):173-180.
[8]Gallagher EJ,Lynn SG.The etiology of medical gridlock:causes of emergency department overcrowding in New York City[J].J Emerg Med,1990,8(6):785-790.
[9]Uscher-Pines L,Pines J,Kellermann A,et al.Emergency department visits for nonurgent conditions:systematic literature review[J].Am J Manag Care,2013,19(1):47-59.
[10]Sprivulis P,Grainger S,Nagree Y.Ambulance diversion is not associated with low acuity patients attending Perth metropolitan emergency departments[J].Emerg Med Australas,2005,17(1):11-15.
[11]Samaras N,Chevalley T,Samaras D,et al.Older patients in the emergency department:a review[J].Ann Emerg Med,2010,56(3):261-269.
[12]Andersson G,Karlberg I.Lack of integration,and seasonal variations in demand explained performance problems and waiting times for patients at emergency departments:a 3 years evaluation of the shift of responsibility between primary and secondary care by closure of two acute hospitals[J].Health Policy,2001,55(3):187-207.
[13]Knapman M,Bonner A.Overcrowding in medium-volume emergency departments:effects of aged patients in emergency departments on wait times for non-emergent triage-level patients[J].Int J Nurs Pract,2010,16(3):310-317.
[14]Pines JM,Asplin BR,Kaji AH,et al.Frequent users of emergency department services:gaps in knowledge and a proposed research agenda[J].Acad Emerg Med,2011,18(6):e64-69.
[15]Hunt KA,Weber EJ,Showstack JA,et al.Characteristics of frequent users of emergency departments[J].Ann Emerg Med,2006,48(1):1-8.
[16]Zuckerman S,Shen YC.Characteristics of occasional and frequent emergency department users:do insurance coverage and access to care matter?[J].Med Care,2004,42(2):176-182.
[17]La Calle E,Rabin E.Frequent users of emergency departments:the myths,the data,and the policy implications[J].Ann Emerg Med,2010,56(1):42-48.
[18]Nugus P,Forero R,McCarthy S,et al.The emergency department“carousel”:an ethnographically-derived model of the dynamics of patient flow[J].Int Emerg Nurs,2014,22(1):3-9.
[19]de Araujo P,Khraiche M,Tukan A.Does overcrowding and health insurance type impact patient outcomes in emergency departments?[J].Health Econ Rev,2013,3(1):25.
[20]Glaser CA,Gilliam S,Thompson WW,et a1.Medical care capacity for influenza outbreaks,Los Angeles[J].Emerg Infect Dis,2002,8(6):569-574.
[21]徐腾达,徐军,吉栩.急诊科拥挤度变化规律研究:昼夜节律和节假日效应[J].中华急诊医学杂志,2011,20(10):1027-1031.
[22]Derlet RW,Richards JR.Overcrowding in the nation's emergency departments:complex causes and disturbing effects[J].Ann Emerg Med,2000,35(1):63-68.
[23]Schull MJ,Lazi er K,Vermeulen M,et al.Emergency department contributors to ambulance diversion:a quantitative analysis[J].Ann Emerg Med,2003,41(4):467-476.
[24]Kocher KE,Meurer WJ,Desmond JS,et al.Effect of testing and treatment on emergency department length of stay using a national database[J].Acad Emerg Med,2012,19(5):525-534.
[25]Sonnenfeld N,Pitts SR,Schappert SM,et al.Emergency department volume and racial and ethnic differences in waiting times in the United States[J].Med Care,2012,50(4):335-341.
[26]Richardson DB,Mountain D.Myths versus facts in emergency department overcrowding and hospital access block[J].Med J Aust,2009,190(7):369-374.
[27]Affleck A,Parks P,Drummond A,et al.Emergency department overcrowding and access block[J].CJEM,2013,15(6):359-370.
[28]Forster AJ,Stiell I,Wells G,et al.The effect of hospital occupancy on emergency department length of stay and patient disposition[J].Acad Emerg Med,2003,10(2):127-133.
[29]叶立刚,张茂,何小军,等.6246例急诊住院危重患者抢救室滞留的Cox回归分析[J].中华急诊医学杂志,2011,20(10):1037-1041.
[30]崔宏冰,姬悠然,张宝胜,等.某三级甲等医院急诊科患者流量和拥挤程度的调查[J].解放军护理杂志,2013,30(18):13-15.
[31]张茂,干建新.重视急诊室的过度拥挤问题[J].中华急诊医学杂志,2011,20(10):1014-1016.
[32]Falvo T,Grove L,Stachura R,et al.The financial impact of ambulance diversions and patient elopements[J].Acad Emerg Med,2007,14(1):58-62.
[33]Huang Q,Thind A,Dreyer JF,et al.The impact of delays to admission from the emergency department on inpatient outcomes[J].BMC Emerg Med,2010,10:16.
[34]Schull MJ,Vermeulen M,Slaughter G,et al.Emergency department crowding and thrombolysis delays in acute myocardial infarction[J].Ann Emerg Med,2004,44(6):577-585.
[35]Fee C,Weber EJ,Maak CA,et al.Effect of emergency department crowding on time to antibiotics in patients admitted with community-acquired pneumonia[J].Ann Emerg Med,2007,50(5):501-509.
[36]Sun BC,Hsia RY,Weiss RE,et al.Effect of emergency department crowding on outcomes of admitted patients[J].Ann Emerg Med,2013,61(6):605-611.
[37]Liu SW,Thomas SH,Gordon JA,et al.A pilot study examining undesirable events among emergency department-boarded patients awaiting inpatient beds[J].Ann Emerg Med,2009,54(3):381-385.
[38]Pines JM,Iyer S,Disbot M,et al.The effect of emergency department crowding on patient satisfaction for admitted patients[J].Acad Emerg Med,2008,15(9):825-831.
[39]毛瑛,李娇凤.人口老龄化呼唤城市社区卫生服务建设[J].中国卫生事业管理,2005,21(11):697-699.
[40]Bicki A,Silva A,Joseph V,et al.A nurse-run walk-in clinic:cost-effective alternative to non-urgent emergency department use by the uninsured[J].J Community Health,2013,38(6):1042-1049.
[41]DeVries A,Li CH,Oza M.Strategies to reduce nonurgent emergency department use:experience of a Northern Virginia Employer Group[J].Med Care,2013,51(3):224-230.
[42]王亚东,刘兰秋,彭迎,等.院前急救与院内急救的衔接[J].中华医院管理杂志,2007,23(12):809-811.
[43]Vilke GM,Castillo EM,Metz MA,et al.Community trial to decrease ambulance diversion hours:the San Diego county patient destination trial[J].Ann Emerg Med,2004,44(4):295-303.
[44]徐思远,胡祖鹏.分层就诊对缓解三级医院非必须急诊就诊现象的探讨[J].中国医院管理,2012,32(9):39-40.
[45]徐腾达,杜铁宽,朱华栋,等.急诊科拥挤缓解策略和Fast Track模式[J].中华急诊医学杂志,2011,20(10):1019-1022.
[46]Kelen GD,Scheulen JJ,Hill PM.Effect of an emergency department managed acute care unit on ED overcrowding and emergency medical services diversion[J].Acad Emerg Med,2001,8(11):1095-1100.
[47]Han JH,Zhou C,France DJ,et al.The effect of emergency department expansion on emergency department overcrowding[J].Acad Emerg Med,2007,14(4):338-343.
[48]Bucheli B,Martina B.Reduced length of stay in medical emergency department patients:a prospective controlled study on emergency physician staffing[J].Eur J Emerg Med,2004,11(1):29-34.
[49]Donald KJ,Smith AN,Doherty S,et al.Effect of an on-site emergency physician in a rural emergency department at night[J].Rural Remote Health,2005,5(3):380.
[50]王明明.SHE排班法在急诊科护士排班中的应用[J].中国护理管理,2013,13(12):92-94.
[51]Stauber MA.Advanced nursing interventions and length of stay in the emergency department[J].J Emerg Nurs,2013,39(3):221-225.
[52]McConnell KJ,Richards CF,Daya M,et al.Effect of increased ICU capacity on emergency department length of stay and ambulance diversion[J].Ann Emerg Med,2005,45(5):471-478.
[53]Hemphill R,Nole B.Relieving an overcrowded ED and increasing capacity for regional transfers:one hospital's bed management strategies[J].J Emerg Nurs,2005,31(3):243-246.
[54]Cha WC,Shin SD,Song KJ,et al.Effect of an independentcapacity protocol on overcrowding in an urban emergency department[J].Acad Emerg Med,2009,16(12):1277-1283.
[2]张晖,王仲,徐腾达,等.急诊科拥挤现象成因分析[J].中华医院管理杂志,2013,29(3):235-238.
[3]于学忠,徐腾达.急诊系统会崩溃吗[J].中华急诊医学杂志,2011,20(10):1013.
[4]徐腾达,马遂,于学忠.急诊医学研究新视角[J].中国急救医学,2010,(3):194-196.
[5]American College of Emergency Physicians.Crowding[J].Ann Emerg Med,2006,47(6):585.
[6]Forero R,McCarthy S,Hillman K.Access block and emergency department overcrowding[J].Crit Care,2011,15(2):216.
[7]Asplin BR,Magid DJ,Rhodes KV,et al.A conceptual model of emergency department crowding[J].Ann Emerg Med,2003,42(2):173-180.
[8]Gallagher EJ,Lynn SG.The etiology of medical gridlock:causes of emergency department overcrowding in New York City[J].J Emerg Med,1990,8(6):785-790.
[9]Uscher-Pines L,Pines J,Kellermann A,et al.Emergency department visits for nonurgent conditions:systematic literature review[J].Am J Manag Care,2013,19(1):47-59.
[10]Sprivulis P,Grainger S,Nagree Y.Ambulance diversion is not associated with low acuity patients attending Perth metropolitan emergency departments[J].Emerg Med Australas,2005,17(1):11-15.
[11]Samaras N,Chevalley T,Samaras D,et al.Older patients in the emergency department:a review[J].Ann Emerg Med,2010,56(3):261-269.
[12]Andersson G,Karlberg I.Lack of integration,and seasonal variations in demand explained performance problems and waiting times for patients at emergency departments:a 3 years evaluation of the shift of responsibility between primary and secondary care by closure of two acute hospitals[J].Health Policy,2001,55(3):187-207.
[13]Knapman M,Bonner A.Overcrowding in medium-volume emergency departments:effects of aged patients in emergency departments on wait times for non-emergent triage-level patients[J].Int J Nurs Pract,2010,16(3):310-317.
[14]Pines JM,Asplin BR,Kaji AH,et al.Frequent users of emergency department services:gaps in knowledge and a proposed research agenda[J].Acad Emerg Med,2011,18(6):e64-69.
[15]Hunt KA,Weber EJ,Showstack JA,et al.Characteristics of frequent users of emergency departments[J].Ann Emerg Med,2006,48(1):1-8.
[16]Zuckerman S,Shen YC.Characteristics of occasional and frequent emergency department users:do insurance coverage and access to care matter?[J].Med Care,2004,42(2):176-182.
[17]La Calle E,Rabin E.Frequent users of emergency departments:the myths,the data,and the policy implications[J].Ann Emerg Med,2010,56(1):42-48.
[18]Nugus P,Forero R,McCarthy S,et al.The emergency department“carousel”:an ethnographically-derived model of the dynamics of patient flow[J].Int Emerg Nurs,2014,22(1):3-9.
[19]de Araujo P,Khraiche M,Tukan A.Does overcrowding and health insurance type impact patient outcomes in emergency departments?[J].Health Econ Rev,2013,3(1):25.
[20]Glaser CA,Gilliam S,Thompson WW,et a1.Medical care capacity for influenza outbreaks,Los Angeles[J].Emerg Infect Dis,2002,8(6):569-574.
[21]徐腾达,徐军,吉栩.急诊科拥挤度变化规律研究:昼夜节律和节假日效应[J].中华急诊医学杂志,2011,20(10):1027-1031.
[22]Derlet RW,Richards JR.Overcrowding in the nation's emergency departments:complex causes and disturbing effects[J].Ann Emerg Med,2000,35(1):63-68.
[23]Schull MJ,Lazi er K,Vermeulen M,et al.Emergency department contributors to ambulance diversion:a quantitative analysis[J].Ann Emerg Med,2003,41(4):467-476.
[24]Kocher KE,Meurer WJ,Desmond JS,et al.Effect of testing and treatment on emergency department length of stay using a national database[J].Acad Emerg Med,2012,19(5):525-534.
[25]Sonnenfeld N,Pitts SR,Schappert SM,et al.Emergency department volume and racial and ethnic differences in waiting times in the United States[J].Med Care,2012,50(4):335-341.
[26]Richardson DB,Mountain D.Myths versus facts in emergency department overcrowding and hospital access block[J].Med J Aust,2009,190(7):369-374.
[27]Affleck A,Parks P,Drummond A,et al.Emergency department overcrowding and access block[J].CJEM,2013,15(6):359-370.
[28]Forster AJ,Stiell I,Wells G,et al.The effect of hospital occupancy on emergency department length of stay and patient disposition[J].Acad Emerg Med,2003,10(2):127-133.
[29]叶立刚,张茂,何小军,等.6246例急诊住院危重患者抢救室滞留的Cox回归分析[J].中华急诊医学杂志,2011,20(10):1037-1041.
[30]崔宏冰,姬悠然,张宝胜,等.某三级甲等医院急诊科患者流量和拥挤程度的调查[J].解放军护理杂志,2013,30(18):13-15.
[31]张茂,干建新.重视急诊室的过度拥挤问题[J].中华急诊医学杂志,2011,20(10):1014-1016.
[32]Falvo T,Grove L,Stachura R,et al.The financial impact of ambulance diversions and patient elopements[J].Acad Emerg Med,2007,14(1):58-62.
[33]Huang Q,Thind A,Dreyer JF,et al.The impact of delays to admission from the emergency department on inpatient outcomes[J].BMC Emerg Med,2010,10:16.
[34]Schull MJ,Vermeulen M,Slaughter G,et al.Emergency department crowding and thrombolysis delays in acute myocardial infarction[J].Ann Emerg Med,2004,44(6):577-585.
[35]Fee C,Weber EJ,Maak CA,et al.Effect of emergency department crowding on time to antibiotics in patients admitted with community-acquired pneumonia[J].Ann Emerg Med,2007,50(5):501-509.
[36]Sun BC,Hsia RY,Weiss RE,et al.Effect of emergency department crowding on outcomes of admitted patients[J].Ann Emerg Med,2013,61(6):605-611.
[37]Liu SW,Thomas SH,Gordon JA,et al.A pilot study examining undesirable events among emergency department-boarded patients awaiting inpatient beds[J].Ann Emerg Med,2009,54(3):381-385.
[38]Pines JM,Iyer S,Disbot M,et al.The effect of emergency department crowding on patient satisfaction for admitted patients[J].Acad Emerg Med,2008,15(9):825-831.
[39]毛瑛,李娇凤.人口老龄化呼唤城市社区卫生服务建设[J].中国卫生事业管理,2005,21(11):697-699.
[40]Bicki A,Silva A,Joseph V,et al.A nurse-run walk-in clinic:cost-effective alternative to non-urgent emergency department use by the uninsured[J].J Community Health,2013,38(6):1042-1049.
[41]DeVries A,Li CH,Oza M.Strategies to reduce nonurgent emergency department use:experience of a Northern Virginia Employer Group[J].Med Care,2013,51(3):224-230.
[42]王亚东,刘兰秋,彭迎,等.院前急救与院内急救的衔接[J].中华医院管理杂志,2007,23(12):809-811.
[43]Vilke GM,Castillo EM,Metz MA,et al.Community trial to decrease ambulance diversion hours:the San Diego county patient destination trial[J].Ann Emerg Med,2004,44(4):295-303.
[44]徐思远,胡祖鹏.分层就诊对缓解三级医院非必须急诊就诊现象的探讨[J].中国医院管理,2012,32(9):39-40.
[45]徐腾达,杜铁宽,朱华栋,等.急诊科拥挤缓解策略和Fast Track模式[J].中华急诊医学杂志,2011,20(10):1019-1022.
[46]Kelen GD,Scheulen JJ,Hill PM.Effect of an emergency department managed acute care unit on ED overcrowding and emergency medical services diversion[J].Acad Emerg Med,2001,8(11):1095-1100.
[47]Han JH,Zhou C,France DJ,et al.The effect of emergency department expansion on emergency department overcrowding[J].Acad Emerg Med,2007,14(4):338-343.
[48]Bucheli B,Martina B.Reduced length of stay in medical emergency department patients:a prospective controlled study on emergency physician staffing[J].Eur J Emerg Med,2004,11(1):29-34.
[49]Donald KJ,Smith AN,Doherty S,et al.Effect of an on-site emergency physician in a rural emergency department at night[J].Rural Remote Health,2005,5(3):380.
[50]王明明.SHE排班法在急诊科护士排班中的应用[J].中国护理管理,2013,13(12):92-94.
[51]Stauber MA.Advanced nursing interventions and length of stay in the emergency department[J].J Emerg Nurs,2013,39(3):221-225.
[52]McConnell KJ,Richards CF,Daya M,et al.Effect of increased ICU capacity on emergency department length of stay and ambulance diversion[J].Ann Emerg Med,2005,45(5):471-478.
[53]Hemphill R,Nole B.Relieving an overcrowded ED and increasing capacity for regional transfers:one hospital's bed management strategies[J].J Emerg Nurs,2005,31(3):243-246.
[54]Cha WC,Shin SD,Song KJ,et al.Effect of an independentcapacity protocol on overcrowding in an urban emergency department[J].Acad Emerg Med,2009,16(12):1277-1283.