急诊科住院时间过长的原因;a跨部门行动研究。

Advanced Journal of Emergency Medicine Pub Date : 2018-02-15 eCollection Date: 2018-01-01 DOI:10.22114/AJEM.v0i0.58
Roya Esmaeili, Seyed-Mojtaba Aghili, Mojtaba Sedaghat, Mohammad Afzalimoghaddam
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引用次数: 6

摘要

引言:根据现有标准,急诊科就诊的患者应在入院后最长6小时内做出决定,并在这段时间内离开急诊科。不幸的是,大多数时候,尤其是在普通医院和转诊医院,我们看到患者在做出决定后在急诊室待了几个小时甚至几天。目的:本研究旨在评估患者在伊朗德黑兰一家主要医院急诊室住院时间过长的原因。方法:本横断面作用研究于2016年11月和12月在伊朗德黑兰伊玛目霍梅尼医院急诊室进行。研究人群包括在急诊室停留超过12小时的患者。在一个由专家组成的小组中,向参与者提出了半结构化和开放式的问题。所有的采访都被记录下来并转换成文本。提取受访者提到的ED停留时间超过12小时的有效因素。编制了一份评估ED住院时间超过12小时原因的清单。在下一阶段,通过每天访问研究医院的急诊室,评估在急诊室停留超过12小时的患者的情况,并评估检查表中确定的变量。结果:在本研究中,407名患者的平均年龄为54.07±20.18岁(最小1岁,最大113岁),其中270名(65.7%)为男性。分别有26人(6.4%)在一级分诊中入院,203人(49.9%)在二级分诊,168人(41.3%)在三级分诊、9人(2.2%)在四级分诊和1人(0.2%)在五级分诊。根据这些发现,“服务机构不想将有决策的患者转移到服务机构”是最常见的因素。结论:在本研究中,专科服务不倾向于将已决定的患者转移到各自的科室,ED患者中有相当多的复杂患者和晚期基础疾病患者,专科部门和ICU床位短缺,是影响患者在研究ED中停留超过12小时的最常见原因。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Causes of Prolonged Emergency Department Stay; a Cross-sectional Action Research.

Introduction: Based on the existing standards, patients presenting to emergency department (ED) should receive a decision in a maximum of 6 hours after admission to ED and leave ED in this time. Unfortunately, most of the time, especially in general and referral hospitals, we witness patients staying in the ED for hours or even days after a decision has been made.

Objective: the present study was performed with the aim of evaluating the causes of patients' prolonged length of stay in ED of one of the major hospitals in Tehran, Iran.

Method: The present cross-sectional action research was carried out in the ED of Imam Khomeini Hospital, Tehran, Iran, in November and December 2016. The studied population consisted of patients who stayed in ED for more than 12 hours. In a panel consist of specialists, semi-structured and open questions were asked from the participants. All the interviews were recorded and converted to text. Effective factors of staying more than 12 hours in ED mentioned by the interviewees were extracted. A checklist of evaluating the causes of more than 12 hours stay in ED was prepared. In the next stage, by daily visit to the ED of the studied hospital, profile of the patients who had stayed in the ED for more than 12 hours was evaluated and the variables determined in the checklist were assessed.

Results: In the present study, 407 patients with the mean age of 54.07±20.18 years (minimum 1 and maximum 113 years) were studied, 270 (65.7%) of which were male. Respectively, 26 (6.4%) were admitted in triage level 1, 203 (49.9%) in triage level 2, 168 (41.3%) in triage level 3, 9 (2.2%) in triage level 4 and 1 (0.2%) in triage level 5. Based on these findings, "services not wanting to transfer patients with decisions to the service" was the most common factor.

Conclusion: In the present study, specialized services not tending to dislocate the patients that have been decided upon to their respective department, a considerable number of complicated patients and patients with advanced underlying illnesses among those presenting to ED, and shortage of beds in specialized departments and ICU, were the most common causes affecting more than 12 hours stay of patients in the studied ED.

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