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Emergency department contributors to ambulance diversion: A quantitative analysis

ANNALS OF EMERGENCY MEDICINE 2003年第4期41卷 467-476页

作者： Schull, MJ Lazier, K Vermeulen, M Mawhinney, S Morrison, LJ Sunnybrook & Womens Coll Hlth Sci Ctr Dept Emergency Serv Toronto ON Canada Toronto Emergency Med Serv Prehosp Res Grp Toronto ON Canada Univ Toronto Div Emergency Med Dept Med Toronto ON Canada Univ Toronto Dept Hlth Adm Toronto ON Canada Dalhousie Univ Fac Med Halifax NS Canada Sunnybrook & Womens Coll Hlth Sci Ctr Clin Epidemiol Unit Toronto ON Canada

Study objective: We determine the relationship between physician, nursing, and patient factors on emergency department use of ambulance diversion. Methods: Data were collected at 1 ED in Toronto, Ontario, Canada, on the duration of ambulance diversion during consecutive 8-hour intervals from January to December 1999 (intervals=1,095). By using time series methods, the association between ambulance diversion and nurse hours, physician on duty, and boarded patients was determined. Covariates included patient volume, assessment time, and boarding time. Results: A total of 37,999 patients were treated in the ED over the study period (2% major trauma, 16% ambulance arrivals, and 22% admitted). Nurse hours per interval averaged 60. A mean of 3.2 admitted patients were boarded in the ED each interval. For admitted patients, the time from registration to admission order and from admission order to ED departure averaged 5.2 and 3.5 hours, respectively. There was no ambulance diversion during 170 (15.5%) intervals, whereas 17 (1.5%) intervals were continuously on diversion. In time series analyses, ambulance diversion increased with the number of admitted patients boarded in the ED (6.2 minutes per patient;95% confidence interval [Cl] 2.6 to 9.8 minutes), the number admitted per interval (4.6 minutes per patient;95% Cl 0.1 to 9.1 minutes), assessment time (9.9 minutes per hour;95% Cl 3.3 to 16.5 minutes), and boarding time (11.3 minutes per hour;95% Cl 5.6 to 17.0 minutes). Thirteen of 15 emergency physicians were not associated with ambulance diversion, 1 was associated with reduced use (-36.3 minutes;95% Cl -65.2 to -7.5 minutes), and 1 was associated with increased use (47.6 minutes;95% Cl 4.5 to 90.6 minutes). ED nurse hours were not associated with diversion. Ambulance-delivered patient volume was associated with diversion (5.2 minutes per patient;95% Cl 2.7 to 7.8 minutes), but walk-in patients and patients with major trauma were not. Conclusion: Admitted patients in th

关键词：救护车/统计学和数值数据方差分析拥挤急救医疗服务通信系统/统计学和数值数据急救医疗服务/统计学和数值数据急诊室医院/统计学和数值数据卫生服务研究医院病床数 500张以上医务人员医院/供应和分配护理人员医院/供应和分配安大略病人入院/统计学和数值数据病人转诊/统计学和数值数据人员配备和时间安排/组织和管理前瞻性研究单盲法时间因素时间和运动研究创伤诊治中心人类

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Elderly patients at highest risk with acute myocardial infarction are more frequently transferred from community hospitals to tertiary centers: Reality or myth?

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AMERICAN HEART JOURNAL 1999年第4期138卷 688-695页

作者： Mehta, RH Stalhandske, EJ McCargar, PA Ruane, TJ Eagle, KA Ctr Hlth Outcomes & Evaluat Plymouth MI USA Univ Michigan Div Cardiol Heart Care Outcomes Assessment Team Ann Arbor MI 48109 USA

Background The objective of this study was to assess the characteristics of patients with acute myocardial infarction transferred from community hospitals. The study was designed as a retrospective chart review, and the data source was the Cooperative Cardiovascular Project from Michigan. Methods and Results included in the study were consecutive Medicare patients with acute myocardial infarction discharged from acute-care hospitals in Michigan between April 1, 1994, and July 31, 1995 (n = 7041): 2866 patients treated at community hospitals, 1241 transferred from community hospitals, 2731 admitted directly to tertiary hospitals, and 203 transferred from an outside emergency room to tertiary hospitals. The outcomes measured were patient characteristics, quality indicators, resource use, and 30-day mortality rates. Compared with patients not transferred, those transferred from community hospitals were younger, more frequently of the male sex, smokers, and were seen earlier after symptom onset. They had fewer cases of diabetes and lower Acute Physiology And Chronic Health Evaluation (APACHE II) scores and Medicare Mortality Prediction System (MMPS) valves. Aspirin during hospitalization and at discharge, thrombolytic therapy and reperfusion therapy were all used more frequently in transferred patients, whereas the other key discharge quality indicators were no different. Mortality rate at 30 days was lower for transferred patients (9.4% vs 25%, P < .0001) when compared with those not transferred. Conclusions Patients who are less ill, those who are seen early, and those who received thrombolytic therapy are more often transferred from community hospitals. On average, patients with greater comorbidity rates are treated at community hospitals and not transferred. Predicted and observed mortality rates were lower for the transferred group. Higher comorbidity rate in patients treated or community hospitals appears to be the major determinant of the observed higher mortalit

关键词：共病现象医院社区/利用医院教学/利用 Medicare/统计学和数值数据密执安/流行病学心肌梗死/流行病学心肌梗死/治疗心肌再灌注/利用病人转诊/统计学和数值数据试点项目卫生保健质量回顾性研究危险因素存活率血栓溶解疗法/利用治疗结果美国老年人女(雌)性人类男(雄)性

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Emergency department crowding: A point in time

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ANNALS OF EMERGENCY MEDICINE 2003年第2期42卷 167-172页

作者： Schneider, SM Gallery, ME Schafermeyer, R Zwemer, FL Univ Rochester Dept Emergency Med Rochester NY 14642 USA Carolinas Med Ctr Charlotte NC 28203 USA Amer Coll Emergency Phys Dallas TX USA

Study objective: This is a pilot study designed to assess the feasibility of a point prevalence study to assess the degree of crowding in hospital emergency departments (EDs). In addition, we sought to measure the degree of physical crowding and personnel shortage in our sample. Methods: A mail survey was sent to a random sample of 250 EDs chosen from a database compiled by the American College of Emergency Physicians of 5,064 EDs in the United States. In addition to demographic information, respondents were asked to count the patients and staff in their EDs at 7 Pm local time on Monday March 12,, 2001 (index time). Results: The response rate was 36%. At the index time, there was an average of 1.1 patients per treatment space, and 52% of EDs reported more than 1 patient per treatment space. There was also evidence of personnel shortage, with a mean of 4.2 patients per registered nurse and 49% of EDs having each registered nurse caring for more than 4 patients. There was a mean of 9.7 patients per physician. Sixty-eight percent of EDs had each physician caring for more than 6 patients. There was crowding present in all geographic areas and all hospital types (teaching-nonteaching status of the hospital). Consistent with the crowded conditions, 11% of institutions were on ambulance diversion and not accepting new acute patients. Delays in transfer of admitted patients out of the ED contributed to the physical crowding. Twenty-two percent of patients in the ED were already admitted and were awaiting transfer to an inpatient bed;73% of EDs were boarding 2 or more inpatients. The amount of crowding quantified by this point prevalence study was confirmed by the amount of crowding reported for the previous week: 48% of EDs were boarding inpatients during the previous week for a mean of 8.9 hours, 4.2 days per week;31% had been on diversion;59% had been routinely using their halls for patients;38% had been doubling their rooms;and 47% had been using nonclinical space for pa

关键词：病床利用率/统计学和数值数据横断面研究拥挤急诊室医院/统计学和数值数据可行性研究卫生服务研究医院病床数/统计学和数值数据室内设计和家俱/统计学和数值数据住院时间/统计学和数值数据医务人员医院/供应和分配需求估价护理人员医院/供应和分配病人转诊/统计学和数值数据人员配备和时间安排/统计学和数值数据医生行政负责人试点项目前瞻性研究时间因素美国人类

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Probabilistic linkage of computerized ambulance and inpatient hospital discharge records: A potential tool for evaluation of emergency medical services

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ANNALS OF EMERGENCY MEDICINE 2001年第6期37卷 616-626页

作者： Dean, JM Vernon, DD Cook, L Nechodom, P Reading, J Suruda, A Univ Utah Sch Med Dept Pediat Intermt Injury Control Res Ctr Salt Lake City UT USA Univ Utah Sch Med Dept Family & Prevent Med Intermt Injury Control Res Ctr Salt Lake City UT USA

Study objectives: Emergency medical services (EMS) is an important part of the health care system. The effect of EMS on morbidity, mortality, and costs of illness is difficult to evaluate because hospital information is not available in out-of-hospital databases. We used probabilistic linkage to create such a database from ambulance and inpatient data and demonstrate the potential for linkage to facilitate evaluation of EMS responses resulting in hospital admission. Methods: Statewide ambulance and inpatient hospital discharge records were available for 1994 through 1946. Ambulance records indicating admission to the emergency department or hospital (165,649 records) were linked to inpatient hospital records indicating emergency admission (146,292 records) by using probabilistic linkage. Out-of-hospital data (dispatch code, treatments rendered, and ages), linkage rates, and inpatient data (discharge status, charges, length of stay, and payer category) were analyzed. Results: We linked 24,299 (14.7%) ambulance events to inpatient hospital discharges. If we had used exact linkage methods, we would have only linked 14,621 record pairs, a loss of nearly 40%. linkage rates were relatively constant between years (approximately 15%) but differed by ambulance dispatch codes. Out-of-hospital dispatch codes with high linkage rates included breathing problems (22.6%), chest pain (21.5%), diabetic problems (16.9%), drowning incidents (14.9%), falls (19.2%), strokes (32.8%), and unconsciousness or fainting episodes (16.1%). Linkage to the hospital record provided access to hospital outcome data. Inpatient mortality was 6.8%. Survivors were discharged home (60.7%), transferred to other acute-care facilities (3.6%) or intermediate-care facilities (23.3%), or discharged with home health care provision (4.9%). The median length of stay was 3 days, and median charges were $6,620;total inpatient charges were $286,737,067. Conclusion: Probabilistic linkage enables ambulance and hospita

关键词：救护车/组织和管理数据库管理系统可行性研究卫生服务研究/方法医院收费/统计学和数值数据医院死亡率信息系统/组织和管理住院病人/统计学和数值数据保险健康/统计学和数值数据住院时间/统计学和数值数据病案连锁/方法病案系统计算机化/组织和管理年患病率结果评价(卫生保健) 病人出院/统计学和数值数据病人转诊/统计学和数值数据概率存活率分析犹他/流行病学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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Trends in special (high-security) hospitals 2: Residency and discharge episodes, 1986-1995

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BRITISH JOURNAL OF PSYCHIATRY 2000年第3期176卷 260-265页

作者： Butwell, M Jamieson, E Leese, M Taylor, P Inst Psychiat Dept Forens Psychiat London England

Background It has been argued-that many patients in special hospital beds do not need to be there. in the 1990s there were initiatives to discharge women and people with learning difficulties. Aims To test for trends in special hospital discharges and to examine annual resident cohorts. Method This study was from case registers and hospital records. The main measures were numbers and annual rates for referrals and beds offered: the Mental Health Act 1983 (MHA) classification of mental disorder;adjusted population rates by region;admission episodes;legal category of detention;admission source and type of offence. Results The median annual number of residents was 1859 (range 1697-1910), with an 8% fall for the period. This particularly affected people in mental impairment categories. Numbers were sustained in the male mental illness groups. Discharges, mainly to other institutions, increased. There was no overall change over the 10 years in length of stay for treatment, but successive admission cohorts from 1986 did show some reduction, even with solely remand order cases excluded. Conclusions Service planners need a longitudinal perspective on service use. Trends over 10 years to both fewer admissions and more discharges have reduced the special hospital population, but despite new treatments for schizophrenia, men under mental illness classification, as well as transfer from other secure settings. have gone against this trend.

关键词：医院精神病/统计学和数值数据医院精神病/发展趋势医院专科/统计学和数值数据医院专科/发展趋势住院时间病人入院/统计学和数值数据病人出院/统计学和数值数据病人转诊/统计学和数值数据性别分布女(雌)性人类男(雄)性

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Selection of a hospital for a transfer: The roles of patients, families, physicians and payers

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Journal of Hospital Marketing 1997年第1期12卷 61-77页

作者： Gombeski, W.R. Konrad, D. Kanoti, G. Ulreich, S. Skilogianis, J. Clough, J. Marketing KK20 The Cleveland Clinic Foundation Cleveland OH 44195 9500 Euclid Avenue United States

Objective. This study investigates the reasons for hospital transfers and the role patients, their families, physicians, and payers play in the choice of a referral center. Data Sources. A thirty-three item questionnaire and clinical data from the hospital's discharge database. Study Design. A study of all 307 hospital transfer patients admitted between November 9 and December 3, 1993 was conducted to understand the factors contributing to the increase in transfers and the reasons patients were sent to CCH. Data on the transfer decision were collected by interviewing patients 48 hours after admittance to the hospital or by telephone if they were discharged before an interview could be completed. Two hundred and sixty-two (85%) patients were interviewed.

关键词：用户参与决策家庭医院联合开业/利用保险范围卫生服务使用研究俄亥俄病人转诊/统计学和数值数据问卷调查转诊和会诊/统计学和数值数据小地区分析成年人老年人女(雌)性人类男(雄)性中年人

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THE DETERMINANTS OF THE HOSPITALIZATION OF NURSING-HOME RESIDENTS

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JOURNAL OF HEALTH ECONOMICS 1993年第3期12卷 349-359页

作者： FREIMAN, MP MURTAUGH, CM AGCY HLTH CARE POLICY & RES CTR GEN HLTH SERV INTRAMURAL RES2101 E JEFFERSON STSUITE 500ROCKVILLEMD 20852 USA

A study analyzes the determinants of the probability that an elderly nursing home resident will be hospitalized over the course of a year. A multinomial logistic model is estimated with 4 possible outcomes for the year: 1. hospitalization, 2. dying in the nursing home prior to hospitalization, 3. leaving the nursing home alive prior to any hospitalization, and 4. remaining in the home for a full year without any hospitalization. The Institutional Population Component (IPC) of the 1987 National Medical Expenditure Survey sample of residents as of January 1, 1987, is analyzed. The overwhelming majority of residents (84%) either were hospitalized during their stay or spent the full year undisturbed in the nursing home. Two important results are found for the financial variables. The rate of payment to the home has a significant and negative effect on the probability of a resident being hospitalized, relative to remaining in the nursing home for the full year. For-profit nursing homes are more likely to hospitalize residents.

关键词：数据收集决策组织预测老人疗养院/经济学老人疗养院/组织和管理住院/经济学住院/统计学和数值数据 Logistic模型医护疗养所/经济学医护疗养所/组织和管理病人转诊/经济学病人转诊/统计学和数值数据偿还途径/经济学美国老年人人类

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Measuring disability and mortality following relocation within the NHS

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AGE AND AGEING 2002年第5期31卷 414-414页

作者： Crome, P Jones, P Keele Univ Postgrad Med Sch N Staffordshire Hosp Dept Geriatr Med Stoke On Trent ST4 7QB Staffs England Keele Univ Postgrad Med Sch N Staffordshire Hosp Dept Math Stoke On Trent ST4 7QB Staffs England

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