埃塞俄比亚东部 HARME 医疗急救中心急诊室过度拥挤及其相关因素

IF 1.4 4区医学 Q3 EMERGENCY MEDICINE African Journal of Emergency Medicine Pub Date : 2023-12-28 DOI:10.1016/j.afjem.2023.12.002

Melaku Getachew , Ibsa Musa , Natanim Degefu , Lemlem Beza , Behailu Hawlte , Fekede Asefa

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引用次数: 0

摘要

导言：急诊科（ED）过度拥挤已成为一个备受关注的问题，因为它可能导致急诊环境中的病人护理受到影响。人们使用了各种工具来评估急诊室过度拥挤的情况。然而，在包括埃塞俄比亚在内的资源有限的国家，有关这一问题的数据还很缺乏。本研究旨在对 NEDOCS 进行验证，评估埃塞俄比亚哈拉尔 Hiwot Fana 综合专科医院 HARME 医疗急救中心的急诊室过度拥挤程度，并确定相关因素。研究人员计算了接收者操作特征曲线下面积（AUC），以评估急诊室拥挤程度的客观评估与主观评估之间的一致性。采用多变量逻辑回归分析来确定与急诊室过度拥挤相关的因素，并以 95% 的置信度和 0.05 的 p 值宣布两者之间存在统计学意义。全国急诊科过度拥挤研究评分与住院医师和病例小组护士的主观评估有很强的相关性，AUC 分别为 0.81 和 0.79。根据住院医师的看法，急诊室在 65.8% 的情况下被认为过度拥挤。与急诊室过度拥挤明显相关的因素包括分诊等待时间（AOR：2.24；95 % CI：1.54-3.27）、工作时间（AOR：2.23；95 % CI：1.52-3.26）、住院时间（AOR：2.40；95 % CI：1.27-4.54）、饱和度（AOR：2.结论研究表明，急诊室大约有三分之二的时间人满为患。

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Emergency department overcrowding and its associated factors at HARME medical emergency center in Eastern Ethiopia

Introduction

Emergency department (ED) overcrowding has become a significant concern as it can lead to compromised patient care in emergency settings. Various tools have been used to evaluate overcrowding in ED. However, there is a lack of data regarding this issue in resource-limited countries, including Ethiopia. This study aimed to validate NEDOCS, assess level of ED overcrowding and identify associated factors at HARME Medical Emergency Center, located in Hiwot Fana Comprehensive Specialized Hospital, Harar, Ethiopia.

Methods

A cross-sectional study was conducted at the HARME Medical Emergency Center, Hiwot Fana Comprehensive Specialized Hospital, involving a total of 899 patients during 120 sampling intervals. The area under the receiver operating characteristic curves (AUC) was calculated to evaluate the agreement between objective and subjective assessments of ED overcrowding. A multivariable logistic regression analysis was employed to identify factors associated with ED overcrowding and statistically significant association was declared using 95 % confidence level and a p-value < 0.05.

Results

The interrater agreement showed a strong correlation with a Cohen's kappa (κ) of 0.80. The National Emergency Department Overcrowding Study Score demonstrated a strong association with subjective assessments from residents and case team nurses, with an AUC of 0.81 and 0.79, respectively. According to residents' perceptions, ED were considered overcrowded 65.8 % of the time. Factors significantly associated with ED overcrowding included waiting time for triage (AOR: 2.24; 95 % CI: 1.54–3.27), working time (AOR: 2.23; 95 % CI: 1.52–3.26), length of stay (AOR: 2.40; 95 % CI: 1.27–4.54), saturation level (AOR: 2.35; 95 % CI: 1.31–4.20), chronic illness (AOR: 2.19; 95 % CI: 1.37–3.53), and abnormal pulse rate (AOR: 1.52; 95 % CI: 1.06–2.16).