{"title":"影响急诊科老年病人住院时间的因素评价。","authors":"Gorkem Alper Solakoglu, Kurtulus Aciksari, Cagatay Nuhoglu, Kamil Oguzhan Doker","doi":"10.14744/nci.2023.59319","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>The emergency department length of stay (EDLOS) is one of the essential parameters of emergency healthcare management efficacy, and prominent factors that contribute to EDLOS are critical in enhancing emergency department (ED) patient care effectiveness, particularly for older patients, which is rarely investigated.</p><p><strong>Methods: </strong>This single-center, prospective cohort study was performed in the ED of a tertiary care hospital. The patients were classified into two groups according to EDLOS (≥4 h vs. <4 h). The chief complaints, consultant branches, the patients' comorbidities, polypharmacy status, time of presentation, laboratory, imaging investigations, EDLOS, Clinical Frailty Score (CFS) score, mini mental examination test, National Early Warning Score 2 (NEWS2), consultations, and outcome of the patients were compared with Spearman and Kendall tau-b correlations.</p><p><strong>Results: </strong>During the 30-day study period, a total of 222 geriatric patients were included in the study. The mean age of study patients was 79.13±9.43 years, and 47.05% of patients were male. The Median EDLOS was 250 (range, 60-1440) min. The patients who arrived on the night shift (p=0.047), who had chronic heart failure (p=0.025), chronic obstructive pulmonary disease (p=0.03), severe dementia according to the MMSE (p=0.008), higher CFS frailty scores (p=0.03), and higher clinical acuity according to the NEWS2 score, were found to be positively correlated to an EDLOS of >4 h. (p=0.001) Any specialty consultation and specialty consultation number, along with hospitalization, were also positively correlated to an EDLOS of >4 h. (p=0.001).</p><p><strong>Conclusion: </strong>High-acuity patients with frailty and dementia are at increased risk for increased EDLOS via consultations. Emergency and consultation physicians should communicate better about which patients are vulnerable to EDLOS case by case, and the patient outcome must be decided as soon as possible.</p>","PeriodicalId":19164,"journal":{"name":"Northern Clinics of Istanbul","volume":"10 4","pages":"444-450"},"PeriodicalIF":0.9000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/17/8f/NCI-10-444.PMC10500236.pdf","citationCount":"0","resultStr":"{\"title\":\"Evaluation of factors affecting the length of stay of geriatric patients in the emergency department.\",\"authors\":\"Gorkem Alper Solakoglu, Kurtulus Aciksari, Cagatay Nuhoglu, Kamil Oguzhan Doker\",\"doi\":\"10.14744/nci.2023.59319\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>The emergency department length of stay (EDLOS) is one of the essential parameters of emergency healthcare management efficacy, and prominent factors that contribute to EDLOS are critical in enhancing emergency department (ED) patient care effectiveness, particularly for older patients, which is rarely investigated.</p><p><strong>Methods: </strong>This single-center, prospective cohort study was performed in the ED of a tertiary care hospital. The patients were classified into two groups according to EDLOS (≥4 h vs. <4 h). The chief complaints, consultant branches, the patients' comorbidities, polypharmacy status, time of presentation, laboratory, imaging investigations, EDLOS, Clinical Frailty Score (CFS) score, mini mental examination test, National Early Warning Score 2 (NEWS2), consultations, and outcome of the patients were compared with Spearman and Kendall tau-b correlations.</p><p><strong>Results: </strong>During the 30-day study period, a total of 222 geriatric patients were included in the study. The mean age of study patients was 79.13±9.43 years, and 47.05% of patients were male. The Median EDLOS was 250 (range, 60-1440) min. The patients who arrived on the night shift (p=0.047), who had chronic heart failure (p=0.025), chronic obstructive pulmonary disease (p=0.03), severe dementia according to the MMSE (p=0.008), higher CFS frailty scores (p=0.03), and higher clinical acuity according to the NEWS2 score, were found to be positively correlated to an EDLOS of >4 h. (p=0.001) Any specialty consultation and specialty consultation number, along with hospitalization, were also positively correlated to an EDLOS of >4 h. (p=0.001).</p><p><strong>Conclusion: </strong>High-acuity patients with frailty and dementia are at increased risk for increased EDLOS via consultations. Emergency and consultation physicians should communicate better about which patients are vulnerable to EDLOS case by case, and the patient outcome must be decided as soon as possible.</p>\",\"PeriodicalId\":19164,\"journal\":{\"name\":\"Northern Clinics of Istanbul\",\"volume\":\"10 4\",\"pages\":\"444-450\"},\"PeriodicalIF\":0.9000,\"publicationDate\":\"2023-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/17/8f/NCI-10-444.PMC10500236.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Northern Clinics of Istanbul\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.14744/nci.2023.59319\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Northern Clinics of Istanbul","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.14744/nci.2023.59319","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
摘要
目的:急诊科住院时间(EDLOS)是急诊医疗保健管理效果的重要参数之一,影响EDLOS的重要因素对提高急诊科(ED)患者(尤其是老年患者)的护理效果至关重要,但相关研究较少。方法:这项单中心、前瞻性队列研究在一家三级护理医院的急诊科进行。根据EDLOS(≥4 h vs.结果)将患者分为两组:在30天的研究期间,共有222例老年患者纳入研究。研究患者平均年龄79.13±9.43岁,男性占47.05%。中位EDLOS为250(范围,60-1440)分钟。夜班(p=0.047)、慢性心力衰竭(p=0.025)、慢性阻塞性肺疾病(p=0.03)、MMSE (p=0.008)、CFS虚弱评分较高(p=0.03)和NEWS2评分较高的患者与EDLOS >4小时呈正相关(p=0.001)。与EDLOS >4 h呈正相关(p=0.001)。结论:高敏度合并虚弱和痴呆患者的EDLOS风险增加。急诊医生和会诊医生应就哪些患者易患EDLOS进行更好的沟通,并且必须尽快确定患者的预后。
Evaluation of factors affecting the length of stay of geriatric patients in the emergency department.
Objective: The emergency department length of stay (EDLOS) is one of the essential parameters of emergency healthcare management efficacy, and prominent factors that contribute to EDLOS are critical in enhancing emergency department (ED) patient care effectiveness, particularly for older patients, which is rarely investigated.
Methods: This single-center, prospective cohort study was performed in the ED of a tertiary care hospital. The patients were classified into two groups according to EDLOS (≥4 h vs. <4 h). The chief complaints, consultant branches, the patients' comorbidities, polypharmacy status, time of presentation, laboratory, imaging investigations, EDLOS, Clinical Frailty Score (CFS) score, mini mental examination test, National Early Warning Score 2 (NEWS2), consultations, and outcome of the patients were compared with Spearman and Kendall tau-b correlations.
Results: During the 30-day study period, a total of 222 geriatric patients were included in the study. The mean age of study patients was 79.13±9.43 years, and 47.05% of patients were male. The Median EDLOS was 250 (range, 60-1440) min. The patients who arrived on the night shift (p=0.047), who had chronic heart failure (p=0.025), chronic obstructive pulmonary disease (p=0.03), severe dementia according to the MMSE (p=0.008), higher CFS frailty scores (p=0.03), and higher clinical acuity according to the NEWS2 score, were found to be positively correlated to an EDLOS of >4 h. (p=0.001) Any specialty consultation and specialty consultation number, along with hospitalization, were also positively correlated to an EDLOS of >4 h. (p=0.001).
Conclusion: High-acuity patients with frailty and dementia are at increased risk for increased EDLOS via consultations. Emergency and consultation physicians should communicate better about which patients are vulnerable to EDLOS case by case, and the patient outcome must be decided as soon as possible.