急诊科分流模式评估

Juan Camilo David Gomez, Amy L. Cochran, Brian W. Patterson, Gabriel Zayas-Cabán
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引用次数: 0

摘要

问题的定义:医院急诊科(ED)越来越多地采用分流模式,即由医生而不是护士进行分流,以改善患者流量。在决定是否采用此类干预措施之前,了解分流模式如何对患者流量和治疗效果产生因果影响非常重要。方法/结果:我们采用因果推理方法,在一家大型三级教学医院估算了分流模式对入室时间、入室后处置时间、入院决定和 ED 复诊的平均因果影响,该医院在每天的某些时段采用了分流模式。我们提出了一种回归不连续设计来识别平均因果效应,并用因果图将其形式化。通过使用电子健康记录数据(n = 21,570),我们估计分流模式会使平均住院时间增加约 4.6 分钟(95% 置信区间(95% CI):2.9-6.2 分钟),但会使平均处置时间减少 14.4 分钟(95% CI:4.1-24.7 分钟),从而全面缩短住院时间。我们还发现,分流可使入院率降低 5.9%(95% CI:2.3%, 9.4%),但并不以重访率的显著变化为代价。最后,我们发现分流模式在减少低拥堵水平下的住院时间方面尤为有效,而中介分析将其部分归因于分流医生的早期任务启动。管理意义:分流模式可以改善流程,并可能对入院率产生下游影响,但不会影响复诊率:本研究得到了美国国立卫生研究院[KL2TR002374 和 UL1TR002373]的资助:在线附录见 https://doi.org/10.1287/msom.2022.0003
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Evaluation of a Split Flow Model for the Emergency Department
Problem definition: Split flow models, in which a physician rather than a nurse performs triage, are increasingly being used in hospital emergency departments (EDs) to improve patient flow. Before deciding whether such interventions should be adopted, it is important to understand how split flows causally impact patient flow and outcomes. Methodology/results: We employ causal inference methodology to estimate average causal effects of a split flow model on time to be roomed, time to disposition after being roomed, admission decisions, and ED revisits at a large tertiary teaching hospital that uses a split flow model during certain hours each day. We propose a regression discontinuity design to identify average causal effects, which we formalize with causal diagrams. Using electronic health records data (n = 21,570), we estimate that split flow increases average time to be roomed by about 4.6 minutes (95% confidence interval (95% CI): 2.9, 6.2 minutes) but decreases average time to disposition by 14.4 minutes (95% CI: 4.1, 24.7 minutes), leading to an overall reduction in length of stay. Split flow is also found to decrease admission rates by 5.9% (95% CI: 2.3%, 9.4%) but not at the expense of a significant change in revisit rates. Lastly, we find that the split flow model is especially effective at reducing length of stay during low congestion levels, which mediation analysis partly attributes to early task initiation by the physician assigned to triage. Managerial implications: A split flow model can improve flow and may have downstream effects on admissions but not revisits.Funding: This work was supported by the National Institutes of Health [Grants KL2TR002374 and UL1TR002373].Supplemental Material: The online appendix is available at https://doi.org/10.1287/msom.2022.0003
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