与分诊室毗邻的医生护士团队可缩短住院时间,减少未就诊时间。

IF 1.9 Q2 EMERGENCY MEDICINE Clinical and Experimental Emergency Medicine Pub Date : 2024-09-06 DOI:10.15441/ceem.24.248
Samita M Heslin, Robert Schwaner, Peter Viccellio, Candice King, Alison Rowe, Henry Thode, Adam J Singer
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引用次数: 0

摘要

导言:人员配备对急诊室的吞吐量有很大影响,但目前注册护士(RN)短缺,影响了急诊室的流量和拥挤程度。非注册护士提供者,如执业护士(LPN),有可能协助完成传统上分配给注册护士的任务。为了改善急诊室的前端流程,我们在分诊室旁设立了主治医师-执业护士团队(PNT),并利用现有的急诊室走廊空间:本研究在一家年门诊量超过 11 万人次的三级医疗急诊室进行。我们比较了干预后(PNT 后)数据(11/1/22-2/28/23)和干预前(PNT 前)数据(7/31/22-10/31/22)。PNT 设在分诊室旁边,为等待开放病房的急诊室患者提供快速护理。他们从候诊室挑选病人绕过主急诊室,在单人病房对他们进行评估,然后将他们转移到走廊等待进一步治疗。我们利用多变量回归分析来衡量不同因素对急诊室住院时间(LOS)的影响:我们分析了 23516 人次的患者就诊情况,其中 10288 人次就诊于 PNT 前阶段,13288 人次就诊于 PNT 后阶段。PNT后包括2454次PNT就诊和10834次非PNT就诊。干预措施带来了明显改善,包括急诊室平均住院时间从 492 分钟降至 425 分钟,72 小时复诊率从 5.1% 降至 4.0%,未就诊而离开的比例从 6.7% 降至 3.3%,到达医疗机构的平均时间从 74 分钟降至 60 分钟。多变量回归分析显示,"PNT 后 "患者的 ED LOS 明显低于 "PNT 前":结论:通过利用 LPNs 的工作范围和现有的急诊室空间,PNT 模型成功地减少了前端瓶颈,从而提高了吞吐量、复诊率和 LWBS 率。
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A Physician Nurse Team Adjacent to Triage Improves Length of Stay and Decreases Left Without Being Seen.

Introduction: Staffing significantly influences ED throughput, however there is a shortage of Registered Nurses (RNs), impacting ED flow and crowding. Non-RN providers, like Licensed Practical Nurses (LPNs), could potentially assist with tasks traditionally assigned to RNs. To improve the front-end ED process, we implemented an Attending Physician-Licensed Practical Nurse Team (PNT) positioned next to triage and utilized existing ED hallway space.

Methods: This study took place at a tertiary care ED with over 110,000 annual visits. We compared postintervention (Post-PNT) data (11/1/22-2/28/23) to pre-intervention (Pre-PNT) data (7/31/22-10/31/22). The PNT, positioned adjacent to triage, expedited care for ED patients awaiting open rooms. They selected patients from the waiting room to bypass the Main ED, evaluated them in a private room, and then moved them to the hallway pending further care. Multivariable Regression Analysis was utilized to measure the impact of different factors on ED Length of Stay (LOS).

Results: We analyzed 23516 patient visits, 10288 in the Pre-PNT period and 13288 in the Post-PNT period. Post-PNT consisted of 2454 PNT visits and 10834 non-PNT visits. The intervention led to significant improvements, including a decrease in mean ED LOS from 492 to 425 minutes, decrease in 72-hour revisits from 5.1% to 4.0%, decrease in Left Without Being Seen from 6.7% to 3.3%, and decrease in mean Arrival-to-Provider time from 74 minutes to 60 minutes. Multivariable Regression Analysis showed that ED LOS was significantly lower for Post-PNT patients than Pre-PNT.

Conclusion: By leveraging the scope of LPNs and utilizing existing ED space, the PNT model successfully reduced front-end bottlenecks, leading to improved throughput, revisit rate, and LWBS rate.

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