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Waiting times in California's emergency departments

ANNALS OF EMERGENCY MEDICINE 2003年第1期41卷 35-44页

作者： Lambe, S Washington, DL Fink, A Laouri, M Liu, HH Fosse, JS Brook, RH Asch, SM Univ Calif Los Angeles Robert Wood Johnson Clin Scholars Program Los Angeles CA 90024 USA Univ Calif Los Angeles Dept Med VA Greater Los Angeles Healthcare Syst Los Angeles CA 90024 USA Univ Calif Los Angeles Dept Med & Publ Hlth Los Angeles CA 90024 USA Calif HealtCare Fdn Oakland CA USA Univ Calif Los Angeles Div Gen Internal Med Los Angeles CA 90024 USA Univ Calif Los Angeles Dept Med & Hlth Serv Los Angeles CA 90024 USA RAND Hlth Santa Monica CA USA

Study objective: Many perceive emergency department crowding as a significant problem that is getting worse. A national survey of ED directors defined crowding, in part, as waiting more than 1 hour to see a physician, a wait considered likely to result in adverse outcomes. Yet few data are available on ED waiting times among a heterogeneous group of hospitals serving a distinct geographic region. Methods: We observed a random sample of 1,798 patients visiting 30 California EDs between December 15, 2000, and May 15, 2001. We defined waiting time as the interval from ED arrival to first contact with a physician or midlevel provider. Results: Patients waited an average of 56 minutes (95% confidence interval [CI] 52 to 61 minutes;median 38 minutes);42% waited longer than 60 minutes. Ordinary least squares regression analysis revealed that waiting times were significantly longer at hospitals in poorer neighborhoods;for every $10,000 decline in per capita income, patients waited 10.1 minutes longer (95% CI 1.8 to 18.4 minutes;P=.02) after adjusting for hospital ownership, teaching status, trauma status, proximity to a recently closed ED, ED volume, patient severity, and age. Lower ratios of physicians and triage nurses to waiting room patient were also associated with longer waits. Conclusion: Waiting times often exceeded the threshold set by a survey of ED directors. Further study is required to examine factors that lead to longer waiting times at hospitals in low-income areas. Physician and nurse staffing should be investigated as a means of reducing waiting times.

关键词：年龄因素算法加利福尼亚数据收集数据说明统计急诊室医院/人力急诊室医院/标准收入病人满意度随机分配回归分析抽样研究时间因素时间安排时间和运动研究创伤诊治中心/人力创伤诊治中心/标准伤病员分拣老年人人类

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Advanced trauma and life support principles: An audit of their application in a rural trauma centre

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IRISH JOURNAL OF MEDICAL SCIENCE 1999年第2期168卷 93-98页

作者： Calleary, JG El-Nazir, AK El-Sadig, O Carolan, PE Joyce, WP Cavan Monaghan Hosp Dept Gen & Vasc Surg Cavan Ireland

In December of 1995 a system of trauma care based on Advanced Trauma Life Support (ATLS) principles was instituted to assess the impact of such principles on trauma care in a rural general hospital setting. This audit reviews the results over a 2 yr period to December 1997. All patients admitted with major trauma (i.e. with life threatening or potentially life threatening injuries) to Cavan General Hospital (CGH) were eligible far inclusion. This numbered 70 patients admitted (for at least 3 days), or who were transferred after resuscitation and stabilization as well as inpatient deaths. Twenty-seven patients who died prior to admission are also reviewed. The endpoints assessed were death, disability and survival 3 months post-accident. Based on injury severity scores 7 per sent of cases suffered fatal non-survivable injury, 20-30 per cent had very serious injury with an overall mortality rate of 17 per cent. The predicted mortality rate was 30 per cent. One-third had their full treatment at CGH with a 76 per cent survival rate, The other two-thirds were transferred for specialist intervention with an overall survival of 80 per cent, a disability rate of 16 per cent and a mortality rate of 4 per cent. No patient died during transportation.

关键词：年龄分布危重病/死亡率危重病/治疗指导方针(主题) 损伤严重度评分爱尔兰/流行病学生命支持疗法/标准医学审核登记农村人口性别分布存活率创伤诊治中心/标准创伤和损伤/诊断创伤和损伤/流行病学创伤和损伤/治疗青少年成年人老年人老年人 80以上儿童儿童学龄前女(雌)性人类婴儿男(雄)性中年人

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Development and implementation of clinical pathways for the management of four trauma diagnoses.

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 1999年第3期21.0卷 4-11;quiz11页

作者： Waters, J.B. Wolff, R.S. Blansfield, J. LaMorte, W.W. Millham, F.H. Hirsch, E.F. Carolinas Medical Center Charlotte NC United States

Clinical pathways are similar to the production algorithms developed by industry. They are being adapted for use in healthcare to reduce resource utilization, decrease variability, and control expenditures. At Boston Medical Center we identified four trauma diagnoses that we believed to be amenable to the design and implementation of clinical pathways: closed head injury, penetrating wound to the abdomen, penetrating wound to the chest, and penetrating wound to an extremity. Upon implementation of these pathways, appropriate nonoperative, single-system, short-stay trauma patients were enrolled in them. This article details the process by which the four diagnoses were identified and the pathways designed, implemented, and evaluated. Preliminary data demonstrate a significant decrease in resource utilization following implementation of the pathways, without an adverse impact on readmission rates, length of stay, or mortality.

关键词：算法波士顿颅脑损伤/治疗临床路径教育继续表格和记录管理医院收费住院时间试点项目过程评价(卫生保健) 创伤诊治中心/经济学创伤诊治中心/标准创伤和损伤/经济学创伤和损伤/病理生理学创伤和损伤/治疗创伤贯通性/治疗人类

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Development of the physician satisfaction survey instrument.

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 1998年第3期20卷 34-38页

作者： Soo Hoo, W.E. Ramer, L. Mercy American River/San Juan Hospital Sacramento CA United States

Continuous quality improvement (CQI) activities depend on valid and reliable instruments to generate data. An evaluation of internal and external customer satisfaction is one of the pillars of the CQI process. This article describes the development of a valid and reliable instrument for measuring physicians' satisfaction with the orthopedic nursing units at a major medical trauma center. The physician satisfaction survey instrument was found to be internally consistent (alpha = .95). Confirmatory factor analysis revealed that 68% of the variance in physician satisfaction scores (eigenvalue = 8.14) was explained by using a single-factor model.

关键词：医务工作者的态度医院专科病房/人力医院专科病房/组织和管理医院专科病房/标准职业满意医务人员医院/心理学护理部医院/标准矫形外科学/人力矫形外科学/标准医生护士关系美国西南部全面质量管理/方法创伤诊治中心/人力创伤诊治中心/组织和管理创伤诊治中心/标准人类

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Is regionalization of trauma care using telemedicine feasible and desirable? Closing

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AMERICAN JOURNAL OF SURGERY 2000年第6期180卷 539-539页

作者： Aucar, J Department of Surgery Baylor College of Medicine and the Ben Taub General Hospital Houston Texas USA

Background: The judgement and skill of an experienced surgeon are crucial ingredients during trauma resuscitation, so that errors of omission, commission, and misprioritization can be avoided. Trauma represents a potential paradigm application for telemedicine owing to its ubiquitous and urgent nature and the limited availability of specialized ***: A two-phase project was performed, using an Advanced Trauma Life Support (ATLS)-based evaluation tool. In phase I, we reviewed 24 videotaped trauma resuscitations on a single pass. Clinical data thus observed were compared with the clinical chart for agreement. In phase II, we performed real time, remote, initial evaluations of 17 trauma ***: In phase I, 19 of 44 variables had agreement rates >90%, 10 had agreement rates between 70% and 90%. In phase II, agreement rates were similar to those in phase I, with improved accuracy in documenting initial and secondary vital signs and the secondary physical ***: Remote evaluation of trauma victims is feasible. Accurate clinical data can be recorded, tasks delegated, and therapeutic measures advised using telemedicine. This can make expert trauma care available to hospitals without advanced trauma systems and potentially reduce cost, prevent unnecessary transfers, and promote early transfer when indicated.

关键词：可行性研究医院综合/标准质量保证卫生保健地区医疗规划/组织和管理地区医疗规划/标准复苏术/标准远程医学得克萨斯创伤诊治中心/组织和管理创伤诊治中心/标准创伤和损伤/诊断人类

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