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A conceptual model of emergency department crowding

ANNALS OF EMERGENCY MEDICINE 2003年第2期42卷 173-180页

作者： Asplin, BR Magid, DJ Rhodes, KV Solberg, LI Lurie, N Camargo, CA Reg Hosp Dept Emergency Med St Paul MN 55101 USA HealthPartners Res Fdn St Paul MN 55101 USA Univ Minnesota Sch Med Dept Emergency Med Minneapolis MN 55455 USA Univ Colorado Hlth Sci Ctr Div Emergency Med Denver CO USA Univ Colorado Hlth Sci Ctr Dept Prevent Med & Biometr Denver CO 80262 USA Univ Colorado Hlth Sci Ctr Clin Res Unit Colorado Permanente Med Grp Denver CO 80262 USA Univ Chicago Hosp Sect Emergency Med Chicago IL 60637 USA HealthPartners Res Fdn Minneapolis MN USA RAND Corp Arlington VA USA Harvard Univ Sch Med Channing Lab Dept Med Boston MA 02115 USA Massachusetts Gen Hosp Dept Emergency Med Boston MA 02114 USA

Emergency department (ED) crowding has become a major barrier to receiving timely emergency care in the United States. Despite widespread recognition of the problem, the research and policy agendas needed to understand and address ED crowding are just beginning to unfold. We present a conceptual model of ED crowding to help researchers, administrators, and policymakers understand its causes and develop potential solutions. The conceptual model partitions ED crowding into 3 interdependent components: input, throughput, and output. These components exist within an acute care system that is characterized by the delivery of unscheduled care. The goal of the conceptual model is to provide a practical framework on which an organized research, policy, and operations management agenda can be based to alleviate ED crowding.

关键词：急性病/治疗病床利用率/统计学和数值数据拥挤效率组织急诊室医院/组织和管理健康计划/组织和管理卫生政策卫生服务易得程度/组织和管理卫生服务研究住院时间/统计学和数值数据模型组织管理需求估价/组织和管理运筹学结果与过程评价(卫生保健)/组织和管理病人入院/统计学和数值数据病人出院/统计学和数值数据研究设计全面质量管理/组织和管理伤病员分拣/组织和管理美国

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Public hospital resource allocations in El Salvador: accounting for the case mix of patients

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HEALTH POLICY AND PLANNING 1998年第3期13卷 296-310页

作者： Fiedler, JL Schmidt, RM Wight, JB Univ Richmond Richmond VA 23173 USA

National hospitals in developing countries command a disproportionate share of medical care budgets, justified on the grounds that they have a more difficult patient case mix and higher occupancy rates than decentralized district hospitals or clinics. This paper empirically tests the hypothesis by developing direct measures of the severity of patient illness, hospital case-mix and a resource intensity index for each of El Salvador's public hospitals. Based on an analysis of inpatient care staffing requirements, national hospitals are found to receive funding far in excess of what case-mix and case-load considerations would warrant. The findings suggest that significant system-wide efficiency gains can be realized by allocating hospital budgets on the bases of performance-related criteria which incorporate the case-mix approach developed here.

关键词：病床利用率/统计学和数值数据预算诊断相关患者组/分类诊断相关患者组/统计学和数值数据效率组织萨尔瓦多/流行病学卫生经费支出/统计学和数值数据卫生资源/分类卫生资源/利用卫生服务研究医院公立/经济学医院公立/组织和管理医院公立/利用年患病率人员配备和时间安排/统计学和数值数据疾病严重程度指数人类

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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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Hospital services as a tool in physician marketing

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Journal of Hospital Marketing 1991年第2期5卷 111-119页

作者： Mainous, Arch G. Shelby, Richard L. CME Research Inc. Lexington KY United States Department of Health Services University of Kentucky Lexington KY United States

The marketing of hospitals to physicians is of importance because of the latter’s hypothesized primacy in health care buying decisions. The notion of marketing to physicians was investigated in terms of types of services offered by hospitals. The results indicated that successfully performing hospitals are more likely to offer high technology services for diagnostic and therapeutic tasks. Further, there was no significant difference between successfully and unsuccessfully performing hospitals in the provision of services marketed to the community. It was concluded that offering these high technology services may be an effective way of marketing hospitals to physicians. © 1991 Taylor & Francis Group, LLC.

关键词：病床利用率/统计学和数值数据评价研究医院管理/统计学和数值数据肯塔基卫生服务使用研究/统计学和数值数据医师转诊和会诊工艺学高成本人类

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Small Rural Hospitals with Long‐Term Care: 1983 to 1987

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The Journal of Rural Health 1992年第2期8卷 121-127页

作者： Beaulieu, Joyce E. Health Administration and of Public Administration Sanders-Brown Center on Aging University of Kentucky Lexington Kentucky United States

Rural hospitals were under tremendous stress in the 1980s, as evidenced by decreasing use and closures. Rural populations increased in the two proportions of people older than 65 years relative to urban areas. Rural communities had more chronically ill residents than urban areas. Population aging and hospital stress have opened an option for small rural hospitals to develop long‐term care units. Analysis of a national cohort of 750 small rural hospitals was undertaken in 1983,1985, and 1987 to identify the characteristics of these hospitals, their communities, and the relative contribution of the small rural hospital to long‐term care bed supply. Hospitals more likely to have long‐term care during this period of time had lower occupancy rates and higher expenses per admission both prior to and after developing long‐term care. While only 14 percent of the 750 hospitals studied had long‐term care, they contributed nearly 30 percent of the total long‐term care bed supply in their counties. Population‐based need and bed supply measures were not significantly different in counties having a small rural hospital with long‐term care. Areas of further analysis of the small rural hospital as a resource for long‐term care are suggested. The implications for the health care system of small rural hospitals with long‐term care are discussed. Copyright © 1992, Wiley Blackwell. All rights reserved

关键词：病床调整/统计学和数值数据病床利用率/统计学和数值数据队列研究数据收集卫生服务需求/统计学和数值数据医院病床数 100张以下医院乡村/统计学和数值数据医院乡村/利用长期医疗/组织和管理美国人类

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Carrying out a bed census at a district hospital in Zambia

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HEALTH POLICY AND PLANNING 1995年第4期10卷 441-445页

作者： Buve, A Foster, S INST TROP MED B-2000 ANTWERPBELGIUM LONDON SCH HYG & TROP MED DEPT PUBL HLTH & POLICYLONDONENGLAND

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An analysis of admission, discharge and bed occupancy of stroke patients aged 65 and over in English hospitals

引用

Health Care Management Science 1998年第2期1卷 151-157页

作者： Lee, Chooi N. Vasilakis, Christos Kearney, Damian Pearse, Rupert Millard, Peter H. Department of Geriatric Medicine St. George's Hospital Medical School University of London London SW17 0RE United Kingdom

Stroke illness is a common problem in the UK. Factors such as incidence, age, and ethnicity have already been shown to affect admission patterns and discharge outcomes. Our analysis of an English Hospital Episode Statistics database shows that weekends and public holidays also influence the admission and discharge patterns of elderly stroke patients. We discuss the possible reasons for this. © Baltzer Science Publishers BV.

关键词：病床利用率/统计学和数值数据病床利用率/发展趋势数据库管理系统英格兰/流行病学医院公立/利用病人入院/统计学和数值数据病人入院/发展趋势病人出院/统计学和数值数据病人出院/发展趋势公费医疗利用情况审核老年人老年人 80以上人类

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EFFECTS OF HMOS ON THE CREATION OF COMPETITIVE MARKETS FOR HOSPITAL SERVICES

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JOURNAL OF HEALTH ECONOMICS 1990年第2期9卷 207-222页

作者： FELDMAN, R CHAN, HC KRALEWSKI, J DOWD, B SHAPIRO, J UNIV MINNESOTA MINNEAPOLISMN 55455 USA

Why do health maintenance organizations (HMOs) use particular hospitals, and do they concentrate patients in hospitals where they obtain low prices? We answered these questions with a study of six HMOs in four large metropolitan areas in 1986. A two-part model was estimated for the probability that a hospital would be used and the demand for general inpatient admissions at hospitals that were used. Four staff-network plans in our study do shop for hospital services on the basis of price more than was generally believed. However, two independent practice association (IPAs) plans use more hospitals in the community and do not concentrate patients effectively at hospitals that offer the lowest prices.

关键词：病床利用率/统计学和数值数据数据收集经济竞争费用和收费健康维护组织/经济学卫生服务需求/经济学医院/利用模型统计学所有权病人入院/统计学和数值数据美国

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Small rural hospitals: An example of market segmentation analysis

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Journal of Hospital Marketing 1991年第2期5卷 73-81页

作者： Mainous, Arch G. Shelby, Richard L. CME Research Inc. Lexington KY 40502 United States Department of Health Services University of Kentucky Lexington KY 405360080 United States

In recent years, market segmentation analysis has shown increased popularity among health care marketers, although marketers tend to focus upon hospitals as sellers. The present analysis suggests that there is merit to viewing hospitals as a market of consumers. Employing a random sample of 741 small rural hospitals, the present investigation sought to determine, through the use of segmentation analysis, the variables associated with hospital success (occupancy). The results of a discriminant analysis yielded a model which classifies hospitals with a high degree of predictive accuracy. Successful hospitals have more beds and employees, and arc generally larger and have more resources. However, there was no significant relationship between organizational success and number of services offered by the institution. © 1991 Taylor & Francis Group, LLC.

关键词：病床利用率/统计学和数值数据判别分析医院病床数 100张以下医院乡村/分类卫生服务使用研究/统计学和数值数据模型统计学病人美国

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The bed census survey: A tool for studying hospital inpatient services

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HEALTH POLICY AND PLANNING 1995年第4期10卷 438-440页

作者： Pannarunothai, S BUDDHACHINARAJ HOSP 28-1 SINGHAWAT RDSOI 4 AMPHUR MUANGPHITSANULOK 65000THAILAND

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